High Blood Pressure: Is Compliance to Medication Necessary?

Not too long ago a study came out that 1 in 4 people are not taking their blood pressure medications on time.  It is a known fact that patients with problematic or chronic diseases don't always take their medications on time and high blood pressure is definitely on that list.   Though at times being forgetful is okay, it is important that this doesn't turn into carelessness.  Not taking your medications on time increases stroke rate and mortality rate.  Small reductions in your blood pressure can be extremely beneficial. For example, a middle aged (between ages 40 and 69) person with a blood pressure reading of 175/105 mm Hg is 8X  (absolute risk increase of 800%) more likely to die of cardiovascular disease in the next 10 years in comparison to a patient of the same age/ethnicity/sex with a BP reading of 115/75 mmHg.

If blood pressure is persistently not controlled, it causes over-exertion of the heart. As the heart continues to pump blood at a normal heart rate of 72 beats per minute against high blood pressure, the heart wall muscles becomes thick and stiff over years, which is called left ventricular hypertrophy (LVH).  As the heart thickens, it cannot efficiently contract or relax normally. Diastolic dysfunction, inability of the heart to relax normally, leads to inefficient pumping of deoxygenated blood and subsequently may cause heart failure. With the progression of LVH, you may suffer from arrhythmia and stroke. Persistent hypertension can lead to hardening of the arteries and atherosclerosis (building of plaque in the arteries), which may cause heart attacks and angina.

Remember: Failure to control your blood pressure can lead to serious health problems.

By controlling your blood pressure, you delay the effects of high blood pressure on your organs to much later on in your life. For every increase in 20/10 mm Hg of blood pressure, there is 2-fold increase mortality and even a small reduction in blood pressure translates in to a benefit. Below are some suggestions to help you control your blood pressure.

v  Simple lifestyle and dietary changes can help reduce blood pressure (See Healthy Lifestyle)

v  Take your blood pressure medications on time and as prescribed (Click Here for More Information)

v  Properly treated high blood pressure should not interfere with daily living

Click Here for more information on high blood pressure and new therapies on the horizon

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Renal Denervation: “ The end of the beginning” Professor Murray Esler at ACC

Professor Murray Esler delivered 45th Annual Louis F. Bishop Lecture at ACC.
Prof. Esler, pioneer of the landmark research that lead to our current understanding of the role of beta-blocker in the treatment of CHF, opened his talk with the question: “Is it the end of the beginning or the end of the end of renal denervation(RDN)? He is as sure as he was before January 9th, 2014 and convinced that the sympathetic nervous system (SNS) has a very important role to play in the pathogenesis of hypertension/ resistant HTN and that RDN has a role in treating patients suffering from this condition. Prof. Esler has been studying the sympathetic nervous system(SNS) for over 20 years and has developed an isotope method to study the role of SNS in circulatory control, exercise physiology, mental stress, obesity, congestive heart failure (CHF) and hypertension (HTN).

He kicked-off his presentation with a data review of the role of SNS in the pathogenesis of CHF, orthostatic intolerance, ventricular and atrial arrhythmia, and HTN. His opening slides consisted of Thomas Willis’s first ever drawing of the sympathetic nervous system from 1664 and moving forward to the work of Claude Bernard (1913, Surgical sympathectomy), William Paton (developed centrally acting anti-adrenergic drugs) he elaborated on the 4 decades of work from multiple continents showing renal denervation (including surgical denervation) inhibits the preferential activation of renal sympathetic outflow in drug resistant HTN. (Perhaps the commonly used drugs are not targeting the primary pathophysiology?) He briefly mentioned the regional norepinephrine spillover and selective reduction of the beta 1 receptor in the heart failure and Carvedilol trials showing the benefit of sympathetic inhibition on the mortality of heart failure patients.

His take on the Symplicity HTN-3: 
The mean reduction of SBP by14 mmHg in the RDN group and by 11.7 mmHg in the sham group is very likely from the execution of the study.

In the US, 88 centers enrolled 360 patients in the RDN arm and were treated by 140 interventionalist out of which 120 interventionalist performed only one procedure each in the trial and that is the only renal RF ablation procedure they have done in their career. “Mea culpa”

There was no marker to confirm that the denervation was achieved. In Symplicity I, 45% reduction in the renal vein norepinephrine spillover was measured in the 10 patients. In 70 pigs 85% reduction of NE renal spillover in the renal vein were noted. The effective ablation was less in those 10 patients than in the animal study. The human use of the Ardian Symplicity catheter is not easy and is usually incomplete. Reduction in NE spillover ranged in wide verity and proved it was operator dependent. Success of denervation is operator dependent. He further mentioned that another possibility is the inefficient first generation device: energy form, intensity and heat penetration. “HTN-3 will be judged to have failed to achieve adequate renal denervation and to be on the wrong side of history”. There are two trials where better BP control was achieved by repeating the procedure – “Or have better device to do first job better”.

When asked about the question of what he tells to the patients about the SYMPLICITY HTN-3 data he said: I tell my patient “You remember that special treatment for your HTN which fixed you up, a large overseas clinical trial showed that it did not work”.

For him, “The real science of renal denervation now begins”. Moving forward some of the current RDN mysteries will need to be solved:

How much RDN is optimal?
How to standardize the denervation?
How to test if denervation is achieved?
Pre-selection of patient”
Will RDN show a “class effect”?

Dr. Murray Esler closed with “It is End of the beginning and not the end of end.”

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Global SYMPLICITY Registry 6-Month Data Reveals Strong Safety Profile And Blood Pressure Reduction

Medtronic, Inc. (NYSE: MDT), announced on March 30th that further analysis of six-month follow-up data from the first 1,000 patients enrolled in the Global SYMPLICITY Registry, which continue to demonstrate the safety of the Symplicity(TM) renal denervation system. Presented today during a late-breaking clinical trial session at the 63rd Scientific Sessions of the American College of Cardiology (ACC), the results of this observational, open-label study show that renal denervation with the Symplicity(TM) renal denervation system resulted in significant reductions in both office and 24-hour ambulatory blood pressure compared to baseline, with very low adverse event rates to six months. The Symplicity(TM) renal denervation system is available for investigational use only in the United States.

Of all patients available for six-month follow-up, overall office systolic blood pressure reduction was -11.9 mm Hg and mean 24-hour ABPM systolic blood pressure reduction was -7.9 mm Hg. For the subset of patients with baseline office SBP ≥ 160 mm Hg, and baseline 24 hour mean ABPM SBP ≥ 135 mm Hg that were treated with at least 3 medication classes, similar to those included in all other Symplicity trials, office systolic blood pressure reduction was -20.2 mm Hg.

“The Global SYMPLICITY Registry provides further evidence confirming the well-established safety profile of renal denervation with the Symplicity system,” said Michael Böhm, M.D., Ph.D., chairman, Department of Internal Medicine, University of Saarland, Homburg/Saar, Germany and Global SYMPLICITY Registry co-chair. “Presented on the heels of SYMPLICITY HTN-3, this real-world experience provides a significant contribution to the discussion about the efficacy of renal denervation and offers additional perspective when considering the option of renal denervation in clinical practice for high-risk patients suffering from uncontrolled hypertension who may have limited treatment options.”

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