Hypertension, But not "Prehypertension," Increases Stroke Risk -- and Should Combination Therapy Include a Calcium Antagonist?

March 16, 2004

In This Article

Introduction

Much of the news in hypertension in the month leading up to the American College of Cardiology Annual Scientific Session 2004 meeting focused on a few main topics: hypertension and the risk of stroke, combination therapy, home vs office blood pressure measurement, additional guidelines for reducing the risk of hypertension, and the global prevalence of hypertension.

The results of studies assessing hypertension, or "prehypertension," as a risk factor for stroke were presented during the 29th International Stroke Conference held February 5-7 in San Diego, California. One study calculated the overall risk of stroke, including in people with above normal blood pressure, for the first time, and assessed the effect of falling within the new seventh report of the Joint National Committee on Prevention, Detection, and Treatment of High Blood Pressure (JNC 7) category of blood pressure known as "prehypertension," referred to by some critics as "a new disease." The result does not confirm that prehypertension is a new disease.

Another study, published by Japanese researchers who have previously reported on the stroke risk associated with the morning surge in blood pressure, appears to have shown that treatment with the calcium channel blocker (CCB) amlodipine can prevent this surge in hypertensive patients, whereas the angiotensin receptor blocker (ARB) valsartan does not.

Simultaneous therapy for multiple cardiovascular risk factors is being increasingly addressed. A formulation that may be only the start of a trend in combination drug therapy has been approved in the United States for patients with concomitant hypertension and dyslipidemia. Some see this as the first step toward a "polypill" for patients at high cardiovascular risk. A retrospective analysis of combination therapy in patients who presented with acute coronary syndromes (ACS) appears to support the concept of the polypill, a proposed combination therapy including aspirin, a statin, antihypertensive therapy, and possibly other drug classes. At the recent 20th meeting of the International Society of Hypertension, the polypill was widely discussed, and its regulatory approval appears to be increasingly viewed as inevitable, despite many misgivings.

Treatment for hypertension based on blood pressure measurement is still controversial, with the advantages of home blood pressure measurement, such as better patient compliance, absence of white coat hypertension, etc, often cited as reasons for its wider use. Belgian researchers, however, appear to have shown in the Treatment of Hypertension Based on Home or Office Blood Pressure (THOP) trial that home blood pressure measurement is not quite ready for prime time and that for the present, it, and ambulatory monitoring, should be regarded as complementary to office measurement for blood pressure evaluation.

Lifestyle modification is recommended for all people with hypertension, and one of the main recommendations, reduction of sodium intake, can have effects similar to single drug therapy, according to JNC 7. New recommendations for sodium chloride (salt) consumption have been published by the US Institute of Medicine. The report also includes suggestions for increasing potassium intake.

Finally, the global prevalence of hypertension may be higher than we think. Based on their review of recently published regional studies from around the world, Tulane University researchers put it at around 30%, rather than the previous estimate of 20%.

processing....