Abstract
Treatment of hypertension remains a challenging task despite the tremendous breakthroughs and advancements in the field. The BP guideline goal is focused on reduction of cardiovascular morbidity and mortality. Lifestyle modifications, i.e., low sodium diet (<2,400 mg/day), regular physical activity, weight loss if overweight/obese serve as the basis for all medications to be effective. Over 125 antihypertensive medications are available in various combinations for initial treatment and compelling indication. If the blood pressure goals are more than 20 mmHg above goal for systolic and above 10 mmHg above goal for diastolic pressure, initiation of two agents is strongly urged. While just over 50 % of the US population is at blood pressure goal (<140/90 mmHg), the problem is the lack of blood pressure control estimated to be almost 41 % in all groups. Thus, major inroads have been made on the use of older antihypertensive agents such as low-dose spironolactone in concert with more effective diuretics as well as new interventional approaches affecting the sympathetic nervous system offer great promise to help improve the patients with true resistant or refractory hypertension. Novel therapies may improve control rates but ultimately appropriate dosing of these medications, enhanced tolerability, and improvement of adherence to medication regimens are necessary for control rates to improve. The aforementioned approaches are the focus of this paper.
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References
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo Jr JL, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42(6):1206–52.
Egan BM, Zhao Y, Axon RN. US trends in prevalence, awareness, treatment, and control of hypertension, 1988–2008. J Am Med Assoc. 2010;303(20):2043–50.
Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365(9455):217–23.
Sarafidis PA, Bakris GL. Resistant hypertension: an overview of evaluation and treatment. J Am Coll Cardiol. 2008;52(22):1749–57.
Verma A, Solomon SD. Optimizing care of heart failure after acute MI with an aldosterone receptor antagonist. Curr Heart Fail Rep. 2007;4(4):183–9.
Nishizaka MK, Zaman MA, Calhoun DA. Efficacy of low-dose spironolactone in subjects with resistant hypertension. Am J Hypertens. 2003;16(11 Pt 1):925–30.
Chapman N, Dobson J, Wilson S, Dahlof B, Sever PS, Wedel H, et al. Effect of spironolactone on blood pressure in subjects with resistant hypertension. Hypertension. 2007;49(4):839–45.
Khosla N, Kalaitzidis R, Bakris GL. Predictors of hyperkalemia risk following hypertension control with aldosterone blockade. Am J Nephrol. 2009;30(5):418–24.
Musini VM, Fortin PM, Bassett K, Wright JM. Blood pressure lowering efficacy of renin inhibitors for primary hypertension: a Cochrane systematic review. J Hum Hypertens. 2009;23(8):495–502.
Uresin Y, Taylor AA, Kilo C, Tschope D, Santonastaso M, Ibram G, et al. Efficacy and safety of the direct renin inhibitor aliskiren and ramipril alone or in combination in patients with diabetes and hypertension. J Renin Angiotensin Aldosterone Syst. 2007;8(4):190–8.
Parving HH, Brenner BM, McMurray JJ, de ZD, Haffner SM, Solomon SD, et al. Aliskiren trial in type 2 diabetes using cardio-renal endpoints (ALTITUDE): rationale and study design. Nephrol Dial Transplant. 2009;24(5):1663–71.
Weber MA, Black H, Bakris G, Krum H, Linas S, Weiss R, et al. A selective endothelin-receptor antagonist to reduce blood pressure in patients with treatment-resistant hypertension: a randomised, double-blind, placebo-controlled trial. Lancet. 2009;374(9699):1423–31.
Bakris GL, Lindholm LH, Black HR, Krum H, Linas S, Linseman JV, et al. Divergent results using clinic and ambulatory blood pressures. Report of a darusentan-resistant hypertension trial. Hypertension. 2010;56(5):824–30.
Bakris GL, Weir MR. Achieving goal blood pressure in patients with type 2 diabetes: conventional versus fixed-dose combination approaches. J Clin Hypertens (Greenwich). 2003;5(3):202–9.
Mancia G, Failla M, Grappiolo A, Giannattasio C. Present and future role of combination treatment in hypertension. J Cardiovasc Pharmacol. 1998;31 Suppl 2:S41–4.
Gradman AH, Basile JN, Carter BL, Bakris GL, Materson BJ, Black HR, et al. Combination therapy in hypertension. J Am Soc Hypertens. 2010;4(2):90–8.
Jamerson K, Weber MA, Bakris GL, Dahlof B, Pitt B, Shi V, et al. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med. 2008;359(23):2417–28.
Jamerson KA, Bakris GL, Weber MA. 24-Hour ambulatory blood pressure in the ACCOMPLISH trial. N Engl J Med. 2010;363(1):98.
Oparil S, Melino M, Lee J, Fernandez V, Heyrman R. Triple therapy with olmesartan medoxomil, amlodipine besylate, and hydrochlorothiazide in adult patients with hypertension: The TRINITY multicenter, randomized, double-blind, 12-week, parallel-group study. Clin Ther. 2010;32(7):1252–69.
Calhoun DA, Crikelair NA, Yen J, Glazer RD. Amlodipine/valsartan/hydrochlorothiazide triple combination therapy in moderate/severe hypertension: secondary analyses evaluating efficacy and safety. Adv Ther. 2009;26(11):1012–23.
Brown MJ, Coltart J, Gunewardena K, Ritter JM, Auton TR, Glover JF. Randomized double-blind placebo-controlled study of an angiotensin immunotherapeutic vaccine (PMD3117) in hypertensive subjects. Clin Sci (Lond). 2004;107(2):167–73.
Tissot AC, Maurer P, Nussberger J, Sabat R, Pfister T, Ignatenko S, et al. Effect of immunisation against angiotensin II with CYT006-AngQb on ambulatory blood pressure: a double-blind, randomised, placebo-controlled phase IIa study. Lancet. 2008;371(9615):821–7.
Ambuhl PM, Tissot AC, Fulurija A, Maurer P, Nussberger J, Sabat R, et al. A vaccine for hypertension based on virus-like particles: preclinical efficacy and phase I safety and immunogenicity. J Hypertens. 2007;25(1):63–72.
Rafiq S, Anand S, Roberts R. Genome-wide association studies of hypertension: have they been fruitful? J Cardiovasc Transl Res. 2010;3(3):189–96.
Katholi RE, Rocha-Singh KJ, Goswami NJ, Sobotka PA. Renal nerves in the maintenance of hypertension: a potential therapeutic target. Curr Hypertens Rep. 2010;12(3):196–204.
Krum H, Schlaich M, Whitbourn R, Sobotka PA, Sadowski J, Bartus K, et al. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study. Lancet. 2009;373(9671):1275–81.
Schlaich MP, Sobotka PA, Krum H, Lambert E, Esler MD. Renal sympathetic-nerve ablation for uncontrolled hypertension. N Engl J Med. 2009;361(9):932–4.
Filippone JD, Bisognano JD. Baroreflex stimulation in the treatment of hypertension. Curr Opin Nephrol Hypertens. 2007;16(5):403–8.
Illig KA, Levy M, Sanchez L, Trachiotis GD, Shanley C, Irwin E, et al. An implantable carotid sinus stimulator for drug-resistant hypertension: surgical technique and short-term outcome from the multicenter phase II Rheos feasibility trial. J Vasc Surg. 2006;44(6):1213–8.
Sanchez LA, Illig K, Levy M, Jaff M, Trachiotis G, Shanley C, et al. Implantable carotid sinus stimulator for the treatment of resistant hypertension: local effects on carotid artery morphology. Ann Vasc Surg. 2010;24(2):178–84.
Heusser K, Tank J, Engeli S, Diedrich A, Menne J, Eckert S, et al. Carotid baroreceptor stimulation, sympathetic activity, baroreflex function, and blood pressure in hypertensive patients. Hypertension. 2010;55(3):619–26.
Tordoir JH, Scheffers I, Schmidli J, Savolainen H, Liebeskind U, Hansky B, et al. An implantable carotid sinus baroreflex activating system: surgical technique and short-term outcome from a multi-center feasibility trial for the treatment of resistant hypertension. Eur J Vasc Endovasc Surg. 2007;33(4):414–21.
Scheffers IJ, Kroon AA, Tordoir JH, de Leeuw PW. Rheos baroreflex hypertension therapy system to treat resistant hypertension. Expert Rev Med Devices. 2008;5(1):33–9.
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Glossary
- ACCOMPLISH
-
Avoiding cardiovascular events through combination therapy in patients living with systolic hypertension.
- ALTITUDE
-
Aliskiren trial in type 2 diabetes using cardio-renal endpoints.
- ASCOT
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Anglo-Scandinavian cardiac outcomes trial.
- ASH
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American Society of Hypertension.
- ATR12181
-
Vaccine against the angiotensin II-type Ia receptor.
- CAD
-
Coronary artery disease.
- CYT006
-
AngQb is a virus-shaped noninfectious particle that is coupled with angiotensin II, a known vasoconstrictor.
- LV
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Left ventricle.
- MRI
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Magnetic resonance imaging.
- Novel therapy
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An approach to reduce blood pressure that has either not been approved yet or recently approved and has less than 5 years of clinical experience.
- PMD3117
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A vaccine against angiotensin I.
- RAS
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Renal artery stenosis.
- Renin inhibitors
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Inhibit the rate limiting enzyme (renin) for the genesis or angiotensin II.
- Resistant hypertension
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Lack of achieving blood pressure goal (<140/90 mmHg) using at least three maximally tolerated doses of antihypertensive agents one of which is a diuretic.
- TRINITY
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Multicenter, randomized, double-blind, parallel-group study of triple combination treatment with olmesartan, amlodipine, and hydrochlorothiazide compared with dual combinations of the individual components.
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Lerma, E., Bakris, G.L. (2012). Novel Pharmacological Approaches in Hypertension Treatment. In: McFarlane, S., Bakris, G. (eds) Diabetes and Hypertension. Contemporary Diabetes. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60327-357-2_14
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DOI: https://doi.org/10.1007/978-1-60327-357-2_14
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