Balancing Pressure

Finding the right combination of drugs to control blood pressure can be a challenge.

IT’S hard to predict which pills will best lower which patient’s high blood pressure, but researchers are hunting ways to better personalise therapy – perhaps even using a blood test.

The work is controversial, challenging today’s usual approach to treating the hypertension that plagues nearly one in three US adults.

Now a trio of studies shows some drug combinations work better for certain populations – and raises the possibility that measuring blood levels of a hormone involved in hypertension might help optimise some people’s care.

The big surprise: Taking a drug that’s a poor match to that hormone level may not just fail to work, it sometimes can trigger a jump in blood pressure.

“The idea that one size fits all doesn’t make a lot of sense,” says Dr Michael Alderman of New York’s Albert Einstein College of Medicine, who supports the blood test approach.

Don’t expect a routine test for that hormone, called renin, any time soon. Many doctors are sceptical because initial research a few decades ago failed to show a clear benefit, says Dr. Ernesto Schiffrin of Canada’s McGill University, a hypertension specialist with the American Heart Association.

“The reality is that trial and error is to some degree what has to be done because patients are different and some patients develop adverse effects with one agent and others don’t,” he says.

But with blood testing now easier and more reliable, some experts say it’s time for broader studies to settle the debate.

“We must redirect our efforts away from the strategy of treating hypertension as one condition,” wrote Wake Forest University public health specialist Dr. Curt Furberg. He pushed renin-guided therapy in an editorial accompanying the new research in this month’s American Journal of Hypertension.

High blood pressure is a leading cause of heart attacks, strokes and kidney failure, and it’s on the rise... [continues]

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