Making a difference in BP control

Small changes can make a big difference in people with high blood pressure.

Dr. Luis Raymond Go, a cardiologist at the Philippine Heart Center, said even a slight decrease in blood pressure level reduces the risk of hypertensives from having a heart attack or stroke.

"Three to four millimeters mercury (mm Hg)" – the unit used for measuring blood pressure – difference in blood pressure could spell a big difference in the outcome," Go said in a symposium during the recent joint convention of the Philippine Society of Hypertension and Philippine Lipid Society.

Go cited the results of the Heart Outcomes Prevention Evaluation (HOPE) study, among others, to prove his point.

In the HOPE study, involving more than 9,000 patients, a 3.3 mm Hg reduction in blood pressure translated in a reduction in the rates of heart attack, cardiovascular death, stroke and heart failure by 27 percent.

Among the new medicines for hypertension, a class of drugs known as angiotensin receptor blocker (ARB), reduces blood pressure better than other antihypertensive drugs by about 3 mm Hg.

Aside from lowering blood pressure, ARB has been shown to protect the kidney and delay the onset of microalbuminuria, an early sign of kidney disease usually common in diabetics.

In a study called Irbesartan in Diabetic Nephropathy Trial (IDNT), patients who took irbesartan, a type of ARB, saw their proteinuria (abnormal amount of protein in the urine) reduced by an average of 33 percent compared with six percent on those treated with amlodipine, a type of hypertensive medicine.

"Most of the benefits of patients would get from antihypertensive drugs is due to the lowering of blood pressure but we cannot discount the fact that the drug itself may offer benefits independent of blood pressure lowering," said Go.

There are other benefits offered by ARB. Among the different classes of antihypertensive drugs, ARB has the highest capability to somehow promote regression of left ventricular hypertrophy (LVH).

LVH is an enlargement of the left pumping chamber of the heart usually caused by high blood pressure.

ARB promotes insulin sensitivity and was shown to prevent onset of new diabetes. The drug also helps lower hospitalization due to heart failure.

One study demonstrates that the ARB has the highest persistence rate among antihypertensive medicines.

"This is important because we want our patients to be maintained on their medicine," said Go. "We don’t want them to stop taking their medicine because they have headaches, bipedal edema or they feel very tired – which are some of the side effects of antihypertensive drugs.