Recent clinical trials in the management of hypertension

This review analyzed new treatment studies investigating the treatment of hypertension published in the past two years.

Although hypertension (high blood pressure) affects millions of people around the world, the treatment of hypertension has proven to be difficult in many cases. Despite this fact, only a few clinical trials have been performed in the past two years investigating new treatments in the management of hypertension.

In the treatment of resistant hypertension (defined as high blood pressure that fails to respond to treatment with three or more types of anti-hypertensive drugs), renal denervation has been the main focus of investigation. Renal denervation is a minimally invasive surgical procedure in which the nerve endings in the wall of the renal artery are destroyed. Several recent studies, although involving only a small number of patients, have shown that renal denervation can significantly reduce blood pressure among resistant hypertensive patients.

Since many classes of anti-hypertensive drugs exist, and more often than not patients are treated with more than one type of medication, different potential drug combinations have been proposed as a possible research avenue. However, the only large trial conducted over the past two years investigating a new combination of anti-hypertensive drugs was terminated prematurely with disappointing results.

Diuretics (drugs that increase urination) have long been the treatment of choice in the management of hypertension. Among the different diuretics, hydrochlorothiazide is the most commonly prescribed drug, being both efficient and safe at a low cost. However, several trials in the past 2 years, including two large meta-analyses (an analysis of data from several similar studies combined), have shown that the diuretic chlorthalidone (Hygroton), rather than hydrochlorothiazide, is more effective at reducing blood pressure and the risk of serious cardiac events (such as heart attacks). The authors concluded that this discrepancy between common practice and medical evidence should be further investigated and settled.   

While it has long been known that lifestyle adjustments play a crucial role in managing hypertension, research aimed at determining the optimal type of diet or exercise is currently receiving much attention. Reducing sodium intake has been validated as the most significant factor influencing overall cardiovascular (heart and blood vessel) health. Low-fat dairy was shown in some studies to be associated with a decreased risk of developing hypertension. Although the benefits of aerobic exercise (such as jogging and many types of sports) are well-established, the effects of anaerobic exercise (such as weight lifting) on hypertension management are still unclear. Over the past two years only a few studies investigated these effects, reporting mixed and inconclusive results.