New advances in the treatment and diagnosis of hypertension in primary care: a literature review

Authors

DOI:

https://doi.org/10.51798/sijis.v5i1.739

Keywords:

Hypertension in primary care, diagnosis, treatment, recent advances

Abstract

Background: Despite the availability of safe and effective antihypertensive drugs, hypertension continues to be a major risk factor for cardiovascular death and morbidity worldwide. This review explores the contemporary landscape of advances in hypertension (HTN) diagnosis and treatment, examining the discordant diagnostic thresholds proposed by American and European guidelines. Methods: An integrative approach was employed, analyzing pertinent literature from sources such as ScienceDirect, Google Scholar, and PubMed. Inclusion criteria encompassed studies on new advances in HTN diagnosis and treatment in primary care, published in English within the last five years (2018-2023). Results: Diagnostic innovations focus on the preference for automated sphygmomanometers and technological advancements, enhancing precision and reliability. Treatment advancements span neurovascular dimensions, including neuromodulation, and innovations in the renin-angiotensin-aldosterone system, showcasing promising drugs like finerenone and esaxerenone. Sodium-glucose cotransporter-2 inhibitors demonstrate efficacy beyond antidiabetic effects. The complexities of renal denervation and its challenges are scrutinized, emphasizing the need for further research. Clinical decision-making underscores risk stratification, lifestyle modifications, and the emerging use of single-pill combinations and individualized treatment plans. Conclusion: The review highlights the multidimensional approach required for optimal HTN management in primary care, encompassing diagnostic innovations, treatment advancements, and individualized strategies. Ongoing research is pivotal for refining diagnostic and therapeutic paradigms in hypertension management.

Author Biographies

Yadyra Cristina Quishpe Chuquitarco, Hospital IESS Quito Sur, Ecuador

General Physician and Researcher at Hospital IESS Quito Sur, Ecuador

Segundo Fernando Morales Quilligana, Technical University of Ambato, Ecuador

University Professor at Technical University of Ambato, Ecuador

Verónica Janneth Guano Andrade, Independent Researcher

Resident physician and researcher, Ecuador

Tannia Elizabeth Huertas López, Instituto Tecnológico Superior España, Ecuador

University Professor, Instituto Tecnológico Superior España, Ecuador. PhD in Technical Sciences

Priscila Maribel Cando Sánchez, Internal Medicine, Hospital General Macas, Ecuador

Internal Medicine, Hospital General Macas, Ecuador. Master’s degree in Human Immunodeficiency

References

Andreadis, Emmanuel A., Costas Thomopoulos, Charalampia V. Geladari, and Vasilios Papademetriou. 2019. “Attended Versus Unattended Automated Office Blood Pressure: A Systematic Review and Meta-Analysis.” High Blood Pressure and Cardiovascular Prevention 26(4): 293–303.

Angeli, Fabio, Gianpaolo Reboldi, and Paolo Verdecchia. 2012. “‘From Apennines to Andes:’ Does Body Mass Index Affect the Relationship between Age and Blood Pressure?” Hypertension 60(1): 6–7.

Angeli, Fabio, Gianpaolo Reboldi, and Paolo Verdecchiac. 2013. “Hypertension around the World: New Insights from Developing Countries.” Journal of Hypertension 31(7): 1358–61.

Azizi, Michel et al. 2018. “Endovascular Ultrasound Renal Denervation to Treat Hypertension (RADIANCE-HTN SOLO): A Multicentre, International, Single-Blind, Randomised, Sham-Controlled Trial.” The Lancet 391(10137): 2335–45.

Baker, William L. et al. 2017. “Effects of Sodium-Glucose Cotransporter 2 Inhibitors on 24-Hour Ambulatory Blood Pressure: A Systematic Review and Meta-Analysis.” Journal of the American Heart Association 6(5).

Bhatt, Deepak L. et al. 2014. “A Controlled Trial of Renal Denervation for Resistant Hypertension.” New England Journal of Medicine 370(15): 1393–1401.

Böhm, Michael et al. 2020. “Efficacy of Catheter-Based Renal Denervation in the Absence of Antihypertensive Medications (SPYRAL HTN-OFF MED Pivotal): A Multicentre, Randomised, Sham-Controlled Trial.” The Lancet 395(10234): 1444–51.

Briasoulis, Alexandros, Omar Al Dhaybi, and George L. Bakris. 2018. “SGLT2 Inhibitors and Mechanisms of Hypertension.” Current Cardiology Reports 20(1).

DiBona, Gerald F., and Murray Esler. 2010. “Translational Medicine: The Antihypertensive Effect of Renal Denervation.” American Journal of Physiology - Regulatory Integrative and Comparative Physiology 298(2).

Dzau, Victor J., and Celynne A. Balatbat. 2019. “Future of Hypertension: The Need for Transformation.” Hypertension 74(3): 450–57.

Fengler, Karl et al. 2019. “A Three-Arm Randomized Trial of Different Renal Denervation Devices and Techniques in Patients With Resistant Hypertension (RADIOSOUND-HTN).” Circulation 139(5): 590–600.

Ferdinand, Keith C., Daniel Harrison, and Adedoyin Johnson. 2020. “The NEW-HOPE Study and Emerging Therapies for Difficult-to-Control and Resistant Hypertension.” Progress in Cardiovascular Diseases 63(1): 64–73.

Forouzanfar, Mohammad H. et al. 2017. “Global Burden of Hypertension and Systolic Blood Pressure of at Least 110 to 115mmHg, 1990-2015.” JAMA - Journal of the American Medical Association 317(2): 165–82.

Head, Geoffrey A., Kristy L. Jackson, and Cindy Gueguen. 2019. “Potential Therapeutic Use of Neurosteroids for Hypertension.” Frontiers in Physiology 10.

Hoyt, Scott B. et al. 2017. “Discovery of Indazole Aldosterone Synthase (CYP11B2) Inhibitors as Potential Treatments for Hypertension.” Bioorganic and Medicinal Chemistry Letters 27(11): 2384–88.

Hunter, Paul G., Fiona A. Chapman, and Neeraj Dhaun. 2021. “Hypertension: Current Trends and Future Perspectives.” British Journal of Clinical Pharmacology 87(10): 3721–36.

Ito, S. et al. 2018. “A DOUBLE BLIND PHASE III STUDY OF ESAXERENONE (CS-3150) COMPARED TO EPLERENONE IN PATIENTS WITH ESSENTIAL HYPERTENSION (ESAX-HTN STUDY).” Journal of Hypertension 36(Supplement 1): e239.

Johnson, Karen C. et al. 2018. “Blood Pressure Measurement in SPRINT (Systolic Blood Pressure Intervention Trial).” Hypertension 71(5): 848–57.

Kitt, Jamie, Rachael Fox, Katherine L. Tucker, and Richard J. McManus. 2019. “New Approaches in Hypertension Management: A Review of Current and Developing Technologies and Their Potential Impact on Hypertension Care.” Current Hypertension Reports 21(6).

Kluger, Aaron Y. et al. 2019. “Class Effects of SGLT2 Inhibitors on Cardiorenal Outcomes.” Cardiovascular Diabetology 18(1).

Krieger, Eduardo M. et al. 2018. “Spironolactone versus Clonidine as a Fourth-Drug Therapy for Resistant Hypertension the REHOT Randomized Study (Resistant Hypertension Optimal Treatment).” Hypertension 71(4): 681–90. https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.117.10662 (January 24, 2024).

Lauder, Lucas et al. 2018. “Anatomical and Procedural Determinants of Ambulatory Blood Pressure Lowering Following Catheter-Based Renal Denervation Using Radiofrequency.” Cardiovascular Revascularization Medicine 19(7): 845–51.

Leontsinis, Ioannis et al. 2020. “Recent Advances in Managing Primary Hypertension.” Faculty Reviews 9. /pmc/articles/PMC7894269/ (January 24, 2024).

Li, Chang et al. 2019. “Vaccine Targeted Alpha 1d-Adrenergic Receptor for Hypertension.” Hypertension 74(6): 1551–62.

Llorens-Cortes, Catherine, and Rhian M. Touyz. 2020. “Evolution of a New Class of Antihypertensive Drugs: Targeting the Brain Renin-Angiotensin System.” Hypertension (Dallas, Tex. : 1979) 75(1): 6–15.

Malik, Aaqib H., and Wilbert S. Aronow. 2022. “Efficacy of Sacubitril/Valsartan in Hypertension.” American Journal of Therapeutics 29(3): E322–33.

Mills, Katherine T. et al. 2016. “Global Disparities of Hypertension Prevalence and Control.” Circulation 134(6): 441–50.

Parati, Gianfranco et al. 2014. “European Society of Hypertension Practice Guidelines for Ambulatory Blood Pressure Monitoring.” Journal of Hypertension 32(7): 1359–66.

Piqueras, Laura, and Maria Jesus Sanz. 2020. “Angiotensin II and Leukocyte Trafficking: New Insights for an Old Vascular Mediator. Role of Redox-Signaling Pathways.” Free Radical Biology and Medicine 157: 38–54.

Salvetti, Massimo et al. 2019. “Unattended versus Attended Blood Pressure Measurement: Relationship with Preclinical Organ Damage.” Hypertension 73(3): 736–42.

Sanidas, Elias A. et al. 2020. “Sodium Glucose Cotransporter 2 (SGLT2) Inhibitors across the Spectrum of Hypertension.” American Journal of Hypertension 33(3): 207–13.

Scalise, Filippo et al. 2020. “Renal Denervation in Patients with End-Stage Renal Disease and Resistant Hypertension on Long-Term Haemodialysis.” Journal of Hypertension 38(5): 936–42.

Schoonhoven, Alexander V.Van et al. 2018. “Cost-Utility of an Objective Biochemical Measure to Improve Adherence to Antihypertensive Treatment.” Hypertension 72(5): 1117–24. https://www.ahajournals.org/doi/abs/10.1161/HYPERTENSIONAHA.118.11227 (January 24, 2024).

Setiadi, Anthony, Willian S. Korim, Khalid Elsaafien, and Song T. Yao. 2018. “The Role of the Blood–Brain Barrier in Hypertension.” Experimental Physiology 103(3): 337–42.

Solomon, Scott D. et al. 2019. “Angiotensin–Neprilysin Inhibition in Heart Failure with Preserved Ejection Fraction.” New England Journal of Medicine 381(17): 1609–20.

Stavropoulos, Konstantinos et al. 2020. “Efficacy and Safety of Renal Denervation for the Management of Arterial Hypertension: A Systematic Review and Meta-Analysis of Randomized, Sham-Controlled, Catheter-Based Trials.” Journal of Clinical Hypertension 22(4): 572–84.

Steinberg, Jonathan S. et al. 2020. “Effect of Renal Denervation and Catheter Ablation vs Catheter Ablation Alone on Atrial Fibrillation Recurrence among Patients with Paroxysmal Atrial Fibrillation and Hypertension: The ERADICATE-AF Randomized Clinical Trial.” JAMA - Journal of the American Medical Association 323(3): 248–55.

Steiner, S. 2016. “Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes.” Zeitschrift fur Gefassmedizin 13(1): 17–18.

Stewart, Merrill H., Carl J. Lavie, and Hector O. Ventura. 2018. “Future Pharmacological Therapy in Hypertension.” Current Opinion in Cardiology 33(4): 408–15.

Takaki, Yoshie et al. 2000. “Biochemical Identification of the Neutral Endopeptidase Family Member Responsible for the Catabolism of Amyloid β Peptide in the Brain.” Journal of Biochemistry 128(6): 897–902.

Trensz, Frederic et al. 2019. “Pharmacological Characterization of Aprocitentan, a Dual Endothelin Receptor Antagonist, Alone and in Combination with Blockers of the Renin Angiotensin System, in Two Models of Experimental Hypertension.” Journal of Pharmacology and Experimental Therapeutics 368(3): 462–73.

Tsioufis, Costas, Roland E. Schmieder, and Giuseppe Mancia, eds. 2016. “Interventional Therapies for Secondary and Essential Hypertension.” http://link.springer.com/10.1007/978-3-319-34141-5 (January 24, 2024).

De Vecchis, Renato, Carmelina Ariano, and Silvia Soreca. 2018. “A New Approach for Hypertension: The Case of Sacubitril/Valsartan Experienced in Randomized Controlled Trials That Selectively Restrict Its Use to the Hypertension of the Elderly.” Journal of Clinical Medicine Research 10(11): 853–54.

Verdecchia, Paolo, Claudio Cavallini, and Fabio Angeli. 2022. “Advances in the Treatment Strategies in Hypertension: Present and Future.” Journal of Cardiovascular Development and Disease 9(3). /pmc/articles/PMC8949859/ (January 24, 2024).

Verdecchia, Paolo, Gianpaolo Reboldi, and Fabio Angeli. 2020. “The 2020 International Society of Hypertension Global Hypertension Practice Guidelines - Key Messages and Clinical Considerations.” European Journal of Internal Medicine 82: 1–6.

Verweij, Pierre et al. 2020. “Randomized Dose-Response Study of the New Dual Endothelin Receptor Antagonist Aprocitentan in Hypertension.” Hypertension 75(4): 956–65.

Visseren, Frank et al. 2021. “2021 ESC Guidelines on Cardiovascular Disease Prevention in Clinical Practice.” European Heart Journal 42(34): 3227–3337.

Whelton, Paul K. et al. 2018. “2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults a Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.” Hypertension 71(6): E13–115.

Williams, Bryan et al. 2018. “2018 ESC/ESH Guidelines for Themanagement of Arterial Hypertension.” European Heart Journal 39(33): 3021–3104.

Yuan, Wenming et al. 2017. “Endothelin-Receptor Antagonist Can Reduce Blood Pressure in Patients with Hypertension: A Meta-Analysis.” Blood Pressure 26(3): 139–49.

Zhou, Bin et al. 2021. “Worldwide Trends in Hypertension Prevalence and Progress in Treatment and Control from 1990 to 2019: A Pooled Analysis of 1201 Population-Representative Studies with 104 Million Participants.” The Lancet 398(10304): 957–80.

Downloads

Published

2024-02-19

How to Cite

Quishpe Chuquitarco, Y. C., Morales Quilligana, S. F., Guano Andrade, V. J., Huertas López, T. E., & Cando Sánchez, P. M. (2024). New advances in the treatment and diagnosis of hypertension in primary care: a literature review. Sapienza: International Journal of Interdisciplinary Studies, 5(1), e24015. https://doi.org/10.51798/sijis.v5i1.739

Issue

Section

Health Sciences - Original Articles