Short Communication - Journal of Evolutionary Medicine ( 2022) Volume 10, Issue 10

View PDF Download PDF

Advancements in Treating of Hypertension

Lucy Jones*
 
Department of Ophthalmology and Vision Sciences, University of Toronto, Canada
 
*Corresponding Author:
 Lucy Jones, Department of Ophthalmology and Vision Sciences, University of Toronto, Canada, Email: edward.margolin@uhn.ca

Received: 03-Oct-2022, Manuscript No. jem-22-81122 ; Editor assigned: 05-Oct-2022, Pre QC No. jem-22-81122 (PQ); Reviewed: 19-Oct-2022, QC No. jem-22-81122; Revised: 24-Oct-2022, Manuscript No. jem-22-81122 (R); Published: 31-Oct-2022, DOI: 10.4303/JEM/236086

Introduction

Cardiovascular disease and fatalities are mostly brought on by hypertension, particularly in low and middle-income nations. Although there are safe, well-tolerated, and affordable Blood Pressure (BP)-lowering treatments available, only 14% of individuals with hypertension have their BP under control to a systolic/diastolic BP of less than 140/90 mm Hg. We present updated hypertension treatment recommendations that were created in compliance with the WHO Handbook for Guideline Development. According to the Grading of Recommendations, Assessment, Development, and Evaluations process, assessments of the evidence were summarised and summary tables were created. The World Health Organization offers the most recent and pertinent evidence-based recommendations for the pharmacological treatment of non-pregnant individuals with hypertension in these guidelines. Adults who have undergone lifestyle change counselling and have an appropriate diagnosis of hypertension are the target audience for the suggestions. The recommended BP treatment objectives, follow-up visit intervals, and optimum utilisation of healthcare professionals in the management of hypertension are all outlined in the guidelines. The recommendations include assistance for selecting mono-therapy or dual therapy, single-pill combination drug therapy, and the application of treatment algorithms for the control of hypertension [1].

The quality of the underlying research, trade-offs between desired and unwanted consequences, patient values, resource concerns, cost-effectiveness, health equity, acceptability, and practicality of various treatment alternatives were all factors that influenced how strong the recommendations were. The guideline’s objective is to promote common methods for the pharmacological treatment and management of hypertension, which, if widely adopted, will raise the proportion of cases of hypertension under control globally.

Description

In the United States, a national Harris interactive poll on hypertension found that only 50% to 60% of the 90% of patients on medication also participated in lifestyle changes to lower blood pressure. Therefore, the majority of hypertension sufferers depend on medication to keep their blood pressure under control. More recent clinical trials indicate that the method of utilising mono-therapy to treat hypertension is not likely to be beneficial in the majority of patients, especially in those who have certain comorbidities (eg: DM, heart failure). Typically, two or more drugs are needed in a variety of circumstances to accomplish the BP objective.

For instance, larger BP reductions were seen with combination medication than with the corresponding mono-therapies in a factorial research with 1461 patients divided into 16 treatment groups and given telmisartan 0, 20, 40, and 80 mg and amlodipine 0, 2.5, 5, and 10 mg for 8 weeks. With over 90% BP response rates, the highest dosage combination of telmisartan 80 mg and amlodipine 10 mg resulted in the largest least square mean systolic/diastolic BP reductions (26.4/20.1 mm Hg; P 0.05 compared with both mono-therapies). Peripheral edoema was most prevalent (17.8%) in the amlodipine 10-mg group, however when combined with telmisartan, the prevalence was significantly reduced. Similar outcomes were seen in another trial comparing olmesartan medoxomil/amlodipine combination treatment to the corresponding mono-therapies, where combination therapy was more successful in lowering blood pressure and achieving BP objectives (44.5%-54% versus 28.5%-30%). On combination medication, more than 70% of patients met their blood pressure targets [2].

The European Society of Cardiology and the ESH Task Force for the Management of Arterial Hypertension have firmly endorsed the idea that starting therapy with two or, if necessary, three medications is reasonable in many situations of hypertension management. Combination treatment has a number of additional benefits. Combining the medications increases compliance by lowering the dose, providing them in a convenient dosing format, and allowing once-daily administration. At lower dosages of each component, there is an additive or synergistic antihypertensive impact, and at the same time, the medications together work to balance out each other’s negative side effects. This aids more individuals in achieving normal blood pressure and may even be successful in populations that are challenging to treat. Early BP normalisation may substantially encourage patients to continue their lifelong treatment regimen. The kind of heart failure systolic dysfunction or diastolic dysfunction in which there is a restriction on diastolic filling and, therefore, in forward output because of increased ventricular stiffness must be considered when treating hypertension in individuals with heart failure. In the therapy of heart failure, diuretics, beta blockers, ACEIs, ARBs, and aldosterone antagonists have been found to lower morbidity and mortality in carefully chosen patients [3].

Because several of these medications have the potential to cause hyperkalemia, it is not advisable to combine ACEIs, ARBs, and aldosterone antagonists. The selection of medications is dependent on the degree of heart failure, left ventricular ejection fraction, previous myocardial infarction, and any other concomitant conditions that may be present. In India, hypertension is the leading cause of disease burden and mortality and the leading health risk factor. It is thought to be a factor in the 1.6 million yearly deaths in India from ischemic heart disease and stroke. Hypertension is a factor in 57% of deaths from stroke and 24% of deaths from coronary heart disease.

According to current estimates, hypertension is one of the most prevalent non-communicable illnesses in India, with a prevalence of 29.8% overall and a greater prevalence in urban regions (33.8% vs. 27.6%, p=0.05). The burden of hypertension is being exacerbated by India’s demographic transition, which includes an increase in the number of old individuals, a sedentary lifestyle, obesity linked to increased urbanisation, and other lifestyle variables including high salt intake, alcohol and cigarette use [4].

Conclusion

HTN is the most prevalent risk factor for Cardiovascular Disease (CVD) and is a significant public health issue with a global reach. It causes around two thirds of cerebrovascular accidents and roughly half of Coronary Heart Disease (CHD). HTN is anticipated to be a factor in 23 million cardiovascular deaths by 2030, with over 85% of these fatalities taking place in low- and middle-income nations. According to studies published between 1980 and 2002, the prevalence of HTN grew more rapidly in emerging nations than it did in industrialised nations. Despite the fact that HTN can be prevented and that early identification and treatment can lower the risk of consequences including heart attack, stroke, heart failure, and renal disease, there is a lack of control of HTN on a global scale. HTN rates are greater in economically developed nations than in less developed nations.

References

Copyright: © 2022 Jones L. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.