New hypertension research looks at stress hormones in early disease, the Quadpill as first Rx, tight BP control for older adults--for a start. We recap 8 new studies.
Hypertension was included as a primary or contributing cause in nearly half a million deaths in the US in 2018, according to data from the Centers for Disease Control and Prevention.
As more is learned about the etiology of the disease and about the factors that contribute to worsening and ameliorating disease course, more effective prevention and management strategies will be available to the frontline primary care providers who treat hypertension every day.
The 8 recent studies summarized in the slides below are an excellent reflection of the breadth of research into all aspects of hypertension and its treatment.
A global view of hypertension. The number of persons aged 30 to 79 years with hypertension doubled from 1990 to 2019, from 648 million to 1.278 billion. Treatment and control have improved, but improvements have varied substantially across countries. A pooled analysis now suggests that reducing prevalence through primary prevention and enhancing treatment and control can be achieved in low- and middle-income countries as well as high-income countries. Lancet.
Stress hormones amplify hypertension risk. Higher urinary stress hormone levels were associated with greater risk of incident hypertension in a recent study. Risk increased per doubling of norepinephrine, epinephrine, dopamine, and cortisol over 6.5-year follow-up, especially among patients aged < 60 years. The findings suggest stress hormones may play a role in hypertension prevention and treatment. Hypertension.
Intensive vs standard BP control. In a study of older patients with hypertension, the incidence of a composite of cardiovascular events was lower with intensive treatment (systolic BP target of 110 to <130 mm Hg) than with standard treatment (target of 130 to <150 mm Hg).The results for most of the individual components also favored intensive treatment. New England Journal of Medicine.
White coat hypertension syndrome put to the test. In answer to the question of whether BP values differ when BP is measured with a doctor present or not, a recent study found that the cardiovascular and neural sympathetic responses to the alerting reaction elicited by BP measurement in the presence of a doctor are almost absent during unattended BP measurement. There may be a modest cardiovascular sympathoinhibition. Hypertension.
Keep it simple with Quadpill. Early treatment with a fixed-dose quadruple quarter-dose combination therapy achieved and maintained greater BP lowering than starting monotherapy in QUARTET, a phase 3 trial. The quadpill contains irbesartan, amlodipine, indapamide, and bisoprolol. At 52 weeks, mean unattended systolic BP remained lower by 7·7 mm Hg and BP control rates were higher in the intervention group (81%) than in the control group (62%). Lancet.
BP variability advances cognitive decline. Long-term BP variability is an independent risk factor for cognitive impairment or dementia, a meta-analysis found. Studies of visit-to-visit BP variability concluded that systolic BP variability increases the risk of dementia and that of cognitive impairment, and visit-to-visit diastolic BP variability also increased the risks. An intervention plan for reducing BP variability could be a target for early prevention of dementia. Hypertension.
Resistance training in HTN both effective and safe. Isometric resistance training (IRT) resulted in clinically meaningful reductions in office systolic and office diastolic BP and appeared to be safe in a systematic review of randomized controlled trials. Novel findings included reductions in central systolic, central diastolic, and 24-h diastolic BP but not 24-h systolic BP. There was no significant increase in the risk of IRT, risk ratio, or the risk difference. Hypertension Research.
Flavonoids, the gut microbiome, and BP. Higher total flavonoid intakes were associated with lower systolic BP in a recent study. In food-based analyses, higher intakes of berries, red wine, and apples/pears were associated with lower systolic BP and pulse pressure. Microbial diversity and abundance play a key role in the associations between flavonoid-rich foods and BP. Up to 15% of the associations may be explained by the gut microbiome. Hypertension.