Lower high blood pressure: Changing the preparation is often more effective than increasing the dose

2023-04-16 13:27:25

Health reduce high blood pressure

Switching the drug is often more effective than increasing the dose

As of 1:27 p.m | Reading time: 3 minutes

Only 25 percent of sick women and 20 percent of men manage to lower their blood pressure despite various means

Quelle: Getty Images/Westend61

Hypertension is widespread, various drug groups can lower blood pressure. But a study shows that certain supplements work better for some people than others. Why is that and what does it mean for therapy?

BHypertensive patients could potentially experience far greater improvements from switching their medication than from a higher dose. Based on the results of their study, Swedish doctors in the journal “JAMA” advocate testing more personalized therapy approaches in the future. However, a German expert doubts that such approaches can currently be implemented in clinical practice.

High blood pressure is a widespread global disease: In 2021, a study by the World Health Organization (WHO) showed that the number of people affected in 200 countries examined doubled to almost 1.3 billion people between 1990 and 2019. According to the German Hypertension League, there are between 20 and 30 million people in Germany. Left untreated, hypertension can lead to kidney damage, heart disease, and stroke. Although there are now various effective drugs, only 25 percent of women and 20 percent of men with the disease are able to achieve their therapy goals, according to the WHO study.

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Scientists from Uppsala University are now investigating the reasons for this. Specifically, the team led by cardiologist Johan Sundström investigated the extent to which the effectiveness of different blood pressure medications differs from person to person. The physicians examined 280 participants to see whether there is an optimal blood pressure medication for each individual patient and thus whether there is potential for personalized blood pressure treatment.

For a total of one year, the subjects alternately took four common medications from different drug classes – thiazide diuretics, ACE inhibitors, angiotensin II antagonists and calcium antagonists. The effects of the drugs varied greatly from person to person, and certain patients achieved lower blood pressure with one drug than another. In addition, switching medications had a greater effect for many subjects than doubling the dose of the current medication.

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According to the authors, this result calls into question the treatment guidelines in numerous countries, according to which the four drug groups examined are equally recommended for all hypertensive patients. “This study provides evidence that widely used antihypertensive drugs vary in effectiveness across individuals, offering the potential for greater blood pressure reduction through personalized therapy,” it says. In a statement, Sundström specifies: “If we customize each patient’s medication, we can achieve a better effect than if we randomly select a drug from one of these four drug groups.”

For Markus van der Giet, hypertensiologist at the Charité in Berlin, such a personalized treatment approach would be desirable, but hardly feasible in practice: “That would mean having patients try all the medications one after the other, which would not work in everyday clinical practice and for would also likely be a frustrating experience for patients.”

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In fact, the authors themselves admit that personalized therapy would require research into biomarkers that would enable such predictions. “However, such biomarkers are by no means as stable as one might think, but can vary in the context of blood collection conditions, as a result of daily fluctuations and temperature changes,” points out van der Giet.

The expert suspects that it could be more appropriate to tailor therapies more to groups of people. For example, calcium antagonists or diuretics would have a good effect in elderly patients whose vessels were losing their elasticity. Beta blockers, on the other hand, are more likely to be indicated for younger sufferers, according to van der Giet.

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