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A Disciplined Approach to Hypertension Management

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Dr Saroj Mondal, Kolkata    19 December 2017

outcomes. Systolic BP targets to reduce CV morbidity and mortality among persons without diabetes still remain uncertain.

ACC/AHA new guidelines published in Hypertension and simultaneously presented at the 2017 AHA Scientific Sessions held from November 11-15 in Anaheim, California have now defined hypertension as a BP ≥130/80 mmHg. Previously published guidelines in 2003 categorized hypertension diagnosis as a BP ≥140/90 mmHg. These new guidelines essentially increase the proportion of hypertensive adults in the United States as well as India.

The 2017 ACC/AHA guidelines also recommend lifestyle modifications, especially for the 9.4% of adults with hypertension who are not appropriate candidates for antihypertensive medications. These include weight loss, smoking cessation, moderation of alcohol consumption and increased physical activity.

A study in JACC found that 45.6% of US adults have hypertension under the new ACC/AHA guidelines. Using the expanded definition for hypertension, the researchers theorized that a greater number of individuals will be diagnosed with high BP and will subsequently be prescribed more potent antihypertensive medications. The investigators of the study suggested that patients are not meeting the new BP target and “a substantial [cardiovascular disease] risk reduction benefit should occur with more intensive antihypertensive medication treatment.”

Azilsartan is the latest ARB to be approved by USFDA for hypertension and has been proven to play an important role in reducing the need for treatment compromise in hypertensive patients as well as patients with comorbidities. Despite use of existing ARBs, patients often remained uncontrolled and required a potent, superior and more efficacious ARB for the treatment of hypertension, which was essentially the rationale behind the discovery of Azilsartan.

Clinical trials demonstrated that Azilsartan is more effective at lowering systolic BP by ambulatory BP monitoring than other ARBs (Olmesartan and Valsartan) as well as the ACEI Ramipril. Another trial also demonstrated that addition of Azilsartan to the CCB amlodipine effectively lowers systolic BP while reducing incidence of peripheral edema. In patients with comorbid hypertension along with diabetes or other kidney disorders, Azilsartan has proved to be more effective at BP control than Olmesartan. Azilsartan is a useful and good choice of drug for lowering BP in patients with essential hypertension, particularly for those not able to tolerate ACEIs. The outlook for treating comorbid hypertension also looks positive with use of Azilsartan.

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