Download Cardiovascular Therapeutics Watch Column

Watch pages
Cardiovascular Therapeutics Watch Column
Both individual patient and public health considerations
are extremely important when addressing a health issue
of the magnitude of hypertension, which, as noted in the
previous column, was recently and authoritatively designated
as the greatest threat to the global burden of disease. 1
While therapeutically beneficial interactions between
individual patients and their physicians are the cornerstone
of the practice of both behavioural medicine and
biopharmaceutical medicine, professional organisations such
as the European Society of Hypertension 2 and the American
Society of Hypertension 3 are actively involved in preparing
and publishing treatment guidelines and Position Papers to
guide the treatment of hypertension. 4-6 Guidelines are also
issued by governmental agencies. 7
systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2013;380:
2224-2260.
2. European Society of Hypertension website. Available at:
http://www.eshonline.
org/ (Accessed 18th August, 2013).
3. American Society of Hypertension website. Available at: http://www.ash-us.org/
(Accessed 18th August, 2013).
4. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of
arterial hypertension: The Task Force for the management of arterial hypertension of the
European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).
J Hypertens. 2013;31:1281-1357.
5. O’Brien E, Parati G, Stergiou G, et al: on behalf of the European Society of of Hypertension
Working Group on Blood Pressure Monitoring. European Society of Hypertension Position
Paper on ambulatory blood pressure monitoring. J Hypertens. 2013;31:1731-1767.
6. American Society of Hypertension Position Papers. Available at: http://www.ash-us.org/
Publications/ASH-Position-Papers.aspx (Accessed 18th August, 2013).
Through these guidelines and Position Papers, clinical
research and individual clinical trials inform clinical practice
and evidence-based medicine. Much research has been
conducted on the blood pressure (BP) consequences of three
related behavioural interventions: increasing physical activity,
losing weight, and modifying dietary habits. 8,9 Accordingly,
the Seventh Report of the Joint National Committee on
Prevention, Detection, Evaluation, and Treatment of High
Blood Pressure (JNC 7) observes that “Adoption of healthy
lifestyles by all persons is critical for the prevention of high
BP and is an indispensable part of the management of
those with hypertension.” 7 With regard to biopharmaceutical
medicine, preapproval clinical trials bring new drugs to
market and provide the information contained within each
drug’s prescribing information (label). This information
concerning the drug’s safety and therapeutic benefit (the
best available information at the time of approval: additional
information is gathered once a drug is being prescribed to
patients) guides treatment decisions at the individual patient
level. Also, as previously noted, clinical trials generate the
evidence contained within treatment practice guidelines,
which have a broader reach across populations of patients. 10
Ongoing and future clinical research in this therapeutic area
therefore continues to influence the choice of target BPs for
various patient populations and treatment algorithms.
Since non-adherence to behavioural interventions is
equally as problematic as non-adherence to biopharmaceutical
interventions, 11-13 considerable research has been directed
at ways of improving adherence, including educational
programmes and the use of the internet. 14-16 While such
strategies have been demonstrated to be successful in
relatively small studies, the challenge is to make them
successful on a much larger public health scale.
A recent and very informative publication by Jennings is
entitled “Recent clinical trials of hypertension management.” 17
It covers pharmacological and non-pharmacological
interventions, and also the treatment of drug-resistant
hypertension, a very ‘hot topic’ in the hypertension literature,
and the topic of our next column.
7. US Department of Health and Human Services. The Seventh Report of the Joint National
Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood
Pressure. Available at: http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.pdf
(Accessed 3rd July, 2013).
8. Shantha GP, Kumar AA, Kahan S, Cheah SY, Cheskin LJ. Intentional weight loss and dose
reductions of antihypertensive medications: a retrospective cohort study. Cardiorenal
Med. 2013;3(1):17-25.
9. Hassapidou M, Papadopoulou S, Vlahavas G, et al. Association of physical activity and
sedentary lifestyle patterns with obesity and cardiometabolic comorbidities in Greek
adults: Data from the National Epidemiological Survey. Hormones (Athens). 2012;12(2):
265-274.
10. Turner
JR,
Hoofwijk
TJ.
1. Lim SS, Vos T, Flaxman AD, et al. A comparative risk assessment of burden of disease and
injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a
12 Journal for Clinical Studies
trials
in
new
drug
development.
11. Turner JR, Strumph P. The moral imperative of improving patient adherence to
pharmacotherapy for cardiodiabesity, Part I: A focus on type 2 diabetes mellitus. Journal
for Patient Compliance. 2012;2(1):32-36.
12. Richards AL, Turner JR. The moral imperative of improving patient adherence
to pharmacotherapy for cardiodiabesity, Part II: A focus on cardiovascular disease.
Journal for Patient Compliance. 2012;2(2):36-41.
13. Turner
JR.
Patient
and
physician
adherence
in
hypertension
management.
J Clin Hypertens (Greenwich). 2013;15:447-452.
14. Ferrara AL, Pacioni D, Di Fronzo V, et al. Lifestyle educational program strongly
increases compliance to nonpharmacologic intervention in hypertensive
patients: a
2-year follow-up study. J Clin Hypertens (Greenwich). 2012;14(11): 767-772.
15. Lauzière TA, Chevarie N, Poirier M, Utzschneider A, Bélanger M. Effects of an
interdisciplinary
education
program
on
hypertension:
A
pilot
study.
Can J Cardiovasc Nurs. 2013;23(2): 12-19.
16. Liu S, Dunford SD, Leung YW, et al. Reducing blood
pressure with Internet-
based interventions: a meta-analysis. Can J Cardiol. 2013;29(5):613-621.
17. Jennings GLR.
Recent clinical trials of hypertension management. Hypertension.
2013;62:3-7.
J. Rick Turner, PhD, is Senior Scientific Director,
Clinical Communications, Quintiles. He is also a Senior
Fellow at the Center for Medicine in the Public Interest,
and a Fellow of the Society of Behavioral Medicine.
Email: [email protected].
Philip Galtry is Vice President and Cardiovascular
Therapeutic
Metabolic
References
Clinical
J Clin Hypertens (Greenwich). 2013;15:306-309.
Strategy
Therapeutic
Head,
Cardiovascular
Delivery
Unit,
and
Quintiles.
Philip holds an Honours degree in Biochemistry from
the University of Bristol, UK, and has worked in the
management of cardiovascular studies for almost 25 years.
Volume 5 Issue 5