Advances in the Treatment Strategies in Hypertension: Present and Future

Abstract

Hypertension is the most frequent chronic and non-communicable disease all over the world, with about 1.5 billion affected individuals worldwide. Its impact is currently growing, particularly in low-income countries. Even in high-income countries, hypertension remains largely underdiagnosed and undertreated, with consequent low rates of blood pressure (BP) control. Notwithstanding the large number of clinical observational studies and randomized trials over the past four decades, it is sad to note that in the last few years there has been an impressive paucity of innovative studies. Research focused on BP mechanisms and novel antihypertensive drugs is slowing dramatically. The present review discusses some advances in the management of hypertensive patients, and could play a clinical role in the years to come. First, digital/health technology is expected to be increasingly used, although some crucial points remain (development of non-intrusive and clinically validated devices for ambulatory BP measurement, robust storing systems enabling rapid analysis of accrued data, physician-patient interactions, etc.). Second, several areas should be better outlined with regard to BP diagnosis and treatment targets. Third, from a therapeutic standpoint, existing antihypertensive drugs, which are generally effective and well tolerated, should be better used by exploiting available and novel free and fixed combinations. In particular, spironolactone and other mineral-corticoid receptor antagonists should be used more frequently to improve BP control. In particular, some drugs initially developed for conditions different from hypertension including heart failure and diabetes have demonstrated to lower BP significantly and should therefore be considered. Finally, renal artery denervation is another procedure that has proven effective in the management of hypertension.

Genetic and phenotypic frequency distribution of ACE, ADRB1, AGTR1, CYP2C9*3, CYP2D6*10, CYP3A5*3, NPPA and factors associated with hypertension in Chinese Han hypertensive patients

“…(3) Patients with previous hypertension history. (4) Patients currently taking antihypertensive drugs of calcium ion antagonists (nifedipine or amlodipine).…”

Fatores de influência da não adesão do tratamento de pacientes com diagnóstico de hipertensão arterial

“…De acordo com os autores Malta et al (2021) Verdecchia, et al, (2022) mencionam que alterações no estilo de vida como controle de peso, cessação do tabagismo e o desenvolvimento de uma dieta hiposssódica são cruciais para o tratamento da hipertensão, no qual o autor aponta que o tratamento medicamentoso deve ser aplicado em casos de ineficácia de medidas não farmacológicas.…”

Application of Several Nano Carriers to Improve the Solubility and the Bioavailability of Carvedilol

“…Patients may need one class of medication or several classes according to WHO guidelines and strategies to control HTN 8 . Selection of pharmacological treatment of hypertension based on several parameters such as age, pregnancy, comorbidity, ethnicity, and specific regimen treatment.…”

“…One of the third generations that are applicable in the markets with several concentrations is carvedilol (CAR) found in the market as monotherapy or in combination with other classes to control HBP, it is lipophilic, act on ß1-and ß2 receptors(non-selective blockers) also has additional advantages of block norepinephrine binding to α1 -adrenergic receptors, so control blood pressure by its mechanism 8 , it reduce tachycardia through inhibition of beta-adrenoreceptors, has an action on α1 -adrenergic receptors relaxes the smooth muscles in the vasculature, leading to reduced peripheral vascular resistance and an overall reduction in blood pressure 19 , 20 , indicated for the chronic therapy of heart failure with reduced ejection fraction (HFREF), reduction arterial BP, left ventricular dysfunction myocardial infarction (MI) in the clinically stable patient. On the other hand, CAR is completely absorbed from GIT.…”

“…On the other hand, CAR is completely absorbed from GIT. However, CAR has several drawbacks such as low aqueous solubility, and hepatic first-pass metabolism rendering its systemic bioavailability very low ranging from 25-35% 21,8 .…”