Pill with two drugs may transform blood pressure treatment

LONDON, Aug 26: A single pill with two drugs could help better manage high blood pressure, say experts.
The 2018 European Society of Cardiology (ESC) and European Society of Hypertension (ESH) Guidelines on arterial hypertension recommend starting most patients on two blood pressure lowering drugs, not one.
Previous recommendation was for step-wise treatment, which meant starting with one drug then adding a second and third if needed.
This suffered from “physician inertia,” in which doctors were reluctant to change the initial strategy despite its lack of success.
At least 80 per cent of patients should have been upgraded to two drugs, yet most remained on one drug.
It is now recognised that a major reason for poor rates of blood pressure control is that patients do not take their pills.
Non-adherence increases with the number of pills, so administering the two drugs (or three if needed) in a single tablet “could transform blood pressure control rates,” state the guidelines published in European Heart Journal.
“The vast majority of patients with high blood pressure should start treatment with two drugs as a single pill. These pills are already available and should massively improve the success of treatment, with corresponding reductions in strokes, heart disease, and early deaths,” said Bryan Williams, ESC Chairperson of the Guidelines Task Force, from the University College London in the UK.
Over one billion people have hypertension (high blood pressure) worldwide. Around 30-45 per cent of adults are affected, rising to more than 60 per cent of people over 60 years of age.
High blood pressure is the leading global cause of premature death, accounting for almost ten million deaths in 2015, of which 4.9 million were due to ischaemic heart disease and 3.5 million were due to stroke.
High blood pressure is also a major risk factor for heart failure, atrial fibrillation, chronic kidney disease, peripheral artery disease, and cognitive decline.
High blood pressure does not usually cause symptoms. However, people with very high blood pressure may have headaches, blurred or double vision, regular nosebleeds, difficulty breathing, chest pain, irregular heartbeat, blood in the urine, confusion, or pounding in the chest, neck, or ears.
Experts recommend that you see your doctor if you have any of these symptoms.
Treatment thresholds in the 2018 Guidelines are less conservative, with drugs recommended for patients who would previously have received lifestyle advice only.
The guidelines state that “treatment should never be denied or withdrawn on the basis of age.”
It is increasingly recognised that frailty, independence and biological, rather than chronological, age determine the tolerability and likely benefit of blood pressure lowering medications.
For people over 80 years who have not yet received blood pressure treatment, therapy should be started if systolic blood pressure is 160 mmHg or above.
People already taking medication should not have it withdrawn at 80 years of age if it is well tolerated. (PTI)