Better Medicines Are an Urgent Need for People With Uncontrolled High Blood Pressure, UAMS Shows
| LITTLE ROCK — A researcher at the University of Arkansas for Medical Sciences (UAMS) reports today that more effective medications are needed to control high blood pressure in many older people.
Muhammad G. Alam, M.D., M.P.H., of the UAMS College of Medicine suggests in the February issue of the American Journal of Hypertension that conventional treatment for uncontrolled isolated systolic hypertension, the cause of high blood pressure in many persons in their 60s and older, is not working.
Dr. Alam, who also treats patients at Central Arkansas Veterans Healthcare System in Little Rock, studied 585 patients. He found that the systolic blood pressure of patients with systolic hypertension was not under control even though they received more medications than patients with the other main type of high blood pressure, diastolic hypertension.
Isolated systolic hypertension is a condition where systolic blood pressure is high but diastolic blood pressure is normal. Systolic blood pressure, the first number, measures the peak pressure in the arteries when the heart beats. Diastolic indicates the pressure in the arteries when the heart is relaxing between beats.
Systolic hypertension tends to afflict people who are in their 60s or older, while the other form of high blood pressure affects younger as well as older persons and is easier to control with diuretics and other medications.
“There is a need to develop new medications that will control isolated systolic hypertension,” Alam said. “Ideally, these medications should effectively lower systolic blood pressure without affecting the diastolic blood pressure and thus decreasing pulse pressure.”
Michael A. Weber, M.D., an editor of the journal commented that Alam’s report “affirms the importance of controlling systolic hypertension. Physicians must pay increased attention to systolic blood pressure since it increases as people age and becomes a major risk factor for heart attacks and strokes.”
“As the U.S. population grows older, physicians will see more patients with isolated systolic blood pressure, a condition that is more difficult to control,” Weber said. “Although there is growing evidence regarding the benefits of controlling isolated systolic hypertension, it remains a difficult treatment problem and as the investigators point out, it may be attributed to a lack of effective medications.”
Nearly 50 million Americans (23 percent of the population) have high blood pressure. Commonly referred to as the silent killer, untreated hypertension prematurely ages the body’s arteries and can lead to strokes, heart attacks and kidney failure, often without warning.
In the study at UAMS and CAVHS, 245 of the patients had uncontrolled hypertension. In the uncontrolled group, 189 patients had uncontrolled isolated systolic hypertension and 56 had uncontrolled diastolic hypertension.
The mean age of patients with uncontrolled systolic hypertension was 68.7 years while the mean age of patients with uncontrolled diastolic hypertension was 56.05 years. Patients with isolated systolic hypertension were receiving more antihypertensive medications compared to patients with uncontrolled diastolic hypertension. Uncontrolled systolic hypertension was defined as a systolic measurement greater than 139 mm Hg and diastolic blood pressure less than 90 mm Hg.
“In our study, most of the patients had access to health care and free medications,” Dr. Alam said. “On average, patients with uncontrolled systolic hypertension were receiving more medications than those with controlled hypertension. This indicates that physicians were attempting to control blood pressure by prescribing additional medications.”
The study authors said 43.1 percent of the patients were on diuretics; 41.9 percent on angiotensin converting enzyme inhibitors, 35 percent on beta-blockers and 32.9 percent on calcium channel blockers, “and none of the blood pressure medications were significantly associated with better blood pressure control.”
Yousri M. Barri, MD; now at Baylor University Medical Center, Dallas, is a co-author of the article, “Systolic Blood Pressure Is the Main Etiology for Poorly Controlled Hypertension.”