Hypertension Treatment- Success or Failure?

Another blog post for PHAR3303! This lecture was actually scheduled for this upcoming Tuesday, but since our lecturer can't make it, last year's lecture has been uploaded online. I've already watched it because I clearly had nothing better to do yesterday :P

I'm really not sure what to write about for this post- there's no lecture outline, and most of this lecture consists of random statistics and stuff. I'm assuming that we don't need to memorise the statistics, and that they're just there for context, so that doesn't leave me with much else to write about. Oh well.

History

Quite a few prominent figures over the past century, such as Stalin and President Roosevelt, suffered strokes and/or other complications related to hypertension. In the 30s to 40s, however, pretty much all we had to treat hypertension were salt free diets, sedatives and even removal of the adrenal glands. It wasn't until the 50s that hypertension research really took off, with some early drugs such as phenoxylbenzamine (an adrenergic blocker with serious side effects).

As mentioned here, the Framingham Study helped us to find out a lot about hypertension and cardiovascular disease. Another important initiative, called the National Health Blood Pressure Educational Program (NHBPEP) started in 1983 to help monitor the effects of drugs and lifestyle changes on hypertension. The NHBPEP also created some guidelines. Despite all of this, we still haven't seen that much improvement in the past 10 years or so. Hypertension, and its associated complications, are still very problematic today.

ASCOT

For some reason, half of this lecture was taken up with talking about the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), so I guess I'll talk about it for a little bit. This was a large study that enrolled 19 257 patients with hypertension. One group was taking atenolol (a β-blocker) and bendroflumethiazide (a diuretic), whereas the other group took amlodipine (a Ca²⁺-channel blocker) and perindopril (an ACE inhibitor). While both groups were relatively similar in terms of blood pressure control, the amlodipine/perindopril group had fewer CVD-related deaths, fewer strokes and improved outcomes on several other measures.

Moving forward

As mentioned, hypertension and its complications are still incredibly problematic. Even though malignant hypertension (see here) is rare, it'd be nice if we could do better.

It's been a while since the last "groundbreaking" class of antihypertensives (the ACE inhibitors). We haven't gotten anything better since then. There has, however, been a new kind of treatment suggested, called renal denervation (i.e. getting rid of some of the nerves between the kidney and brain as signalling between the two is partially responsible for influencing blood pressure). Evidence on this treatment, however, is still a bit mixed. Lifestyle changes are also important: smoking, less alcohol, weight loss, exercise and relaxation can all help reduce blood pressure.

And... that's it, I guess?