BP control key component of CVD prevention
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BP control is an important part of CVD prevention, but better evidence is needed, as is more tailored outreach to at-risk populations, a speaker said at the American Society for Preventive Cardiology Congress on CVD Prevention.
Suzanne Oparil, MD, FACC, FAHA, FASH, FAPS, distinguished professor of medicine, professor of cell, developmental and integrated biology, holder of the United Therapeutics Endowed Professorship in Pulmonary Vascular Disease and director of the Vascular Biology and Hypertension Program at the University of Alabama at Birmingham, said in the Leaders in Medicine Lecture that to improve the evidence base for hypertension prevention and early intervention, “we are going to be launching newer randomized controlled trials with younger participants who are at lower cardiovascular risk and who will necessitate longer follow-up.”
The epidemiological evidence suggests prevention and early treatment of hypertension “may prevent cardiovascular disease outcomes, but we don’t have randomized controlled trial evidence of this,” Oparil said. “Traditional trials cannot address the effects of early intervention. It would be too expensive to take a 20-year-old person without an ounce of atherosclerosis and try to find out whether treating his blood pressure would prevent a heart attack.”
Instead, clinicians must evaluate that question using surrogate outcomes such as LV structure and function, vascular stiffness and coronary calcium scores, she said.
Also helpful, she said, would be to develop clinical and population-based strategies for reducing risk factors such as diabetes, obesity and sedentary behavior.
Trials to evaluate BP control as a preventive strategy need to base entry criteria on home BP or ambulatory BP measurements, use intermediate endpoints and employ new strategies for robust long-term follow-up, according to Oparil.
Strategies for improving BP control include improving adherence “by using combination pills, as it’s a lot easier for a patient to take one pill per day than it is to take two or three, and we need to promote lifestyle modification,” she said. “We have neglected in large part the effects of physical activity on improving blood pressure control.”
Also important, she said, is team-based care, including nurses and pharmacists as well as physicians. “A single MD is not likely to do a very good job of managing blood pressure,” she said.
Oparil said a 2019 paper in Hypertension by Victor J. Dzau, MD, president of the National Academy of Medicine, and a colleague identified five areas in need of transformation in order to improve BP management: technical efforts to develop novel mechanistically based therapies, digital monitoring and health promotion, use of precision medicine and artificial intelligence, better use of population science to improve health care delivery, including more access for underserved populations and more consistent care for all patients.
The future “depends on the regulation of our health care system [and] which of these strategies gets pushed the hardest,” she said. “But I think things will change. We know now that we are losing the fight.”
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Oparil S. Opening Session. Presented at: American Society for Preventive Cardiology Congress on CVD Prevention; July 23-25, 2021 (virtual meeting).
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