This article reviewed the recent advances in the treatment of hypertension (HTN) as published in the latest clinical trials.
During the past two years, a large focus has been given to the treatment of resistance hypertension. It is defined as persistently high blood pressure despite medical treatment with at least 3 blood pressure lowering drugs. Most of the interest has been focused on interventions that target the nervous system. Catheter-based procedures are minimally invasive techniques that involves inserting a small wire through the artery of the hand or the groin to reach the target organ. Two such procedure are renal denervation and carotid baroreceptor stimulation, both have been shown to dramatically improve blood pressure control. Renal sympathetic denervation involves disruption of nerve ends in the artery of the kidneys (the renal artery). Carotid baroreceptor stimulation involves implanting a small electrical device near nerve ends in the artery of the neck (the carotid artery).
Drug therapies have also evolved in recent years, and different drug combinations are the focus of investigation. Combining drugs from different classes (drugs with different mechanisms of action) has been shown to be useful, while combining drugs from similar classes does not generally show benefit, and comes at the cost of adverse events. One such example is the combination of aliskiren (Tekturna) with another drug of the ACE inhibitor class. Both drugs share the same mechanism of action.
Thiazides are a class of diuretic drugs, that increase the volume and frequency of urination thereby reducing blood pressure. Despite evidence (clinical studies) in favor of the thiazide-like drug chlorthalidone (Hygroton) and the thiazide bendroflumethiazide (Aprinox), another thiazide called hydrochlorothiazide (Aquazide H) is more often used in clinical practice.
Management of HTN usually involves lifestyle modifications. The dietary approaches to stop hypertension (DASH) diet – a low-sodium diet – has continued to show benefit in blood pressure management. Adopting the DASH diet plan continues to be recommended by every guideline. Weight loss in the obese and overweight is also recommended, however, recent trials have shown that not all patients show a similar degree of blood pressure reduction in response. The mechanisms behind this variability is now under further investigation and might open new avenues of treatment.
Aerobic (isotonic) exercise, such as regular walking, is well established as an effective way for lowering blood pressure and reducing cardiovascular risk (i.e. heart attacks, stroke). Resistance exercise (high-intensity, short duration exertion) on the other hand is still under debate.
Published By :
May 20, 2013