TREATMENT-RESISTANT HYPERTENSION AND WHAT RESEARCHERS HAVE LEARNED

-

 

TREATMENT-RESISTANT HYPERTENSION AND WHAT RESEARCHERS HAVE LEARNED




Medication keeps the condition at bay for many patients with Hypertension- an elevated blood pressure that can lead to stroke or heart attack. But what happens when the medication that physicians usually prescribe doesn't work? Known as apparent resistant Hypertension (aRH), this form of high blood pressure requires more medicine and medical management.

Novel research from investigators in the Smidt Heart Institute at Cedars-Sinai, published today in the peer-reviewed journal Hypertension, found that aRH prevalence was lower in a real-world sample than previously reported but still relatively frequent -- affecting nearly 1 in 10 hypertensive patients.

Through their analysis, investigators also learned that patients with well-managed aRH were more likely to be treated with a commonplace medication called mineralocorticoid receptor antagonist, or MRA. These MRA treatments were used in 34% of patients with controlled aRH but only 11% of patients with uncontrolled aRH.

"Apparent resistant hypertension is more common than many would anticipate," said Joseph Ebinger, MD, assistant professor of Cardiology at the Smidt Heart Institute and corresponding author of the study. "We also learned that within this high-risk population, there are large differences in how providers treat high blood pressure, exemplifying a need to standardize care."

Study findings were based on a unique design, which used clinically generated data from the electronic health records of three large, geographically diverse healthcare organizations. Of the 2,420,468 patients analyzed in the study, 55% were hypertensive. Of these hypertension patients, 8.5%, or 113,992 individuals, met the criteria for aRH.

According to Ebinger, treating aRH can be as tricky as diagnosing it.

In fact, the "apparent" in apparent resistant Hypertension stems from the fact that before diagnosis, medical professionals must first rule out other potential reasons for a patient's blood pressure to be high.

These reasons might include medication non-adherence, inappropriate medication selection, or artificially elevated blood pressure in the doctor's office -- known as "white coat hypertension."

"Large amounts of data tell us that patients with aRH, compared to those with non-resistant forms of hypertension, are at greatest risk for adverse cardiovascular events," said Ebinger, director of Clinical Analytics at the Smidt Heart Institute. "Identifying these patients and possible causes for their elevated blood pressure is increasingly important."

The takeaway, Ebinger says, is awareness -- for both medical professionals and patients. He says providers should be mindful that if taking four or more antihypertensive medications to control a patient's blood pressure, they should consider evaluating alternative causes of Hypertension or refer patients to a specialist.

Similarly, patients should lean on their medical providers to help them navigate the complex disease, including discussing strategies for remembering to take their medication and addressing possible treatment side effects.

Treating patients with complex cardiac issues like aRH is at the heart of Cedars-Sinai's expertise.

The Smidt Heart Institute was recently awarded the American Heart Association's Comprehensive Hypertension Center Certification, recognizing the institute's commitment to following proven, research-based treatment guidelines to care for people with complex or difficult-to-treat Hypertension.

"This accreditation, coupled with our clinical and research expertise in hypertensive diseases, serves as a mark of excellence," said Christine M. Albert, MD, MPH, chair of the Department of Cardiology and the Lee and Harold Kapelovitz Distinguished Chair in Cardiology. "These efforts signal to patients, healthcare providers, and the community that the Smidt Heart Institute is committed to delivering evidence-based, comprehensive care for hypertension."

Funding: This work was partly supported by Cedars-Sinai Medical Center and by the National Institutes of Health grant K23-HL153888.

Comments

Post a Comment

Popular posts from this blog

PEOPLE WITH OBESITY BURN LESS CALORIES DURING THE DAY

-
Image
  PEOPLE WITH OBESITY BURN LESS CALORIES DURING THE DAY Building on prior studies with healthy-weight participants, the new research includes different body sizes.         New research indicates that weight influences how and when bodies burn energy. An Oregon Health & Science University study published in the journal  Obesity  found people who have a healthy weight use more energy during the day, when most people are active and eat, while those who are obese spend more energy during the night when most people sleep. The study also found that during the day, those with obesity have higher levels of the hormone insulin -- a sign that the body is working harder to use glucose, an energy-packed sugar. "It was surprising to learn how dramatically the timing of when our bodies burn energy differed in those with obesity," said the study's first author, Andrew McHill, Ph.D., an assistant professor at the OHSU School of Nursing and the Oregon Institute of Occupational Health
Read more

WHAT CAUSES ITCHING, AND WHAT STOPS IT?

-
Image
  WHAT CAUSES ITCHING, AND WHAT STOPS IT?         It can be a relief to scratch the occasional itch, but when itch gets out of control, it can become a severe health problem. How does the body know when to stop? Scientists at UC San Francisco are getting close to an answer. In a breakthrough that could transform how doctors treat conditions from eczema to allergies, they have discovered a feedback loop centered on a single immune protein called IL-31 that causes the urge to itch and dials back nearby inflammation. The findings, published on October 13th in  Science Immunology , lay the groundwork for a new generation of drugs that interact more intelligently with the body's innate self-regulating ability. Previous approaches suggested that IL-31 signals itch and promotes skin inflammation. However, the UCSF team discovered that nerve cells, or neurons, that respond to IL-31, triggering a scratch, also prevent immune cells from overreacting and causing more widespread irritation. &q
Read more

A VEGAN DIET IMPROVES CARDIOVASCULAR HEALTH, ACCORDING TO A NEW STUDY

-
Image
  A VEGAN DIET IMPROVES CARDIOVASCULAR HEALTH, ACCORDING TO A NEW STUDY         In a study with 22 pairs of identical twins, Stanford Medicine researchers and their colleagues have found that a vegan diet improves cardiovascular health in as little as eight weeks. Although it's well-known that eating less meat improves cardiovascular health, diet studies often need to be enhanced by genetic differences, upbringing, and lifestyle choices. By studying identical twins, however, the researchers were able to control for genetics and limit the other factors, as the twins grew up in the same households and reported similar lifestyles. "Not only did this study provide a groundbreaking way to assert that a vegan diet is healthier than the conventional omnivore diet, but the twins were also a riot to work with," said Christopher Gardner, Ph.D., the Rehnborg Farquhar Professor and a professor of medicine. "They dressed the same, they talked the same, and they had a banter betwe
Read more