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Novel Pharmacological Approaches in Hypertension Treatment

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Diabetes and Hypertension

Part of the book series: Contemporary Diabetes ((CDI))

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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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Author information

Authors and Affiliations

  1. Section of Nephrology, University of Illinois at Chicago School of Medicine, Chicago, IL, USA

    Edgar Lerma

  2. Department of Medicine, ASH Comprehensive Hypertension Center, University of Chicago Medical Center, 5841 S. Maryland Avenue, MC1027, Chicago, IL, 60637, USA

    George L. Bakris M.D.

Authors
  1. Edgar Lerma
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  2. George L. Bakris M.D.
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Corresponding author

Correspondence to George L. Bakris M.D. .

Editor information

Editors and Affiliations

  1. County Hospital, Division of Endocrinology,, SUNY-Downstate and Kings, 450 Clarkson Ave., Brooklyn, 11203, New York, USA

    Samy I. McFarlane

  2. ASH Comprehensive Hypertension Center, Department of Medicine, University of Chicago Medical Center, 5841 S. Maryland Avenue, MC1027, Chicago, 60637, Illinois, USA

    George L. Bakris

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

Anglo-Scandinavian cardiac outcomes trial.

ASH

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

Left ventricle.

MRI

Magnetic resonance imaging.

Novel therapy

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

A vaccine against angiotensin I.

RAS

Renal artery stenosis.

Renin inhibitors

Inhibit the rate limiting enzyme (renin) for the genesis or angiotensin II.

Resistant hypertension

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

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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© 2012 Springer Science+Business Media New York

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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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  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-60327-356-5

  • Online ISBN: 978-1-60327-357-2

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