The year in hypertension: Novel treatment options, a new era for renal denervation and more
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Key takeaways:
- A speaker highlighted key advances in the treatment of hypertension in 2024.
- Topics included insights on the timing of blood pressure medication; impact of bariatric surgery vs. medical therapy on BP; and more.
In the past year, there have been a number of practice-changing trials and approvals for the management of hypertension.
At the Cardiometabolic Health Congress (CMHC) in October, Keith C. Ferdinand, MD, the Gerald S. Berenson Endowed Chair in Preventive Cardiology, professor of medicine in the John W. Deming Department of Medicine at Tulane University School of Medicine and a member of the Healio | Cardiology Today Editorial Board, highlighted the following advancements in hypertension care, in no particular order.
Aprocitentan approved to treat hypertension
In March, Idorsia announced that the FDA approved aprocitentan (Tryvio), a joint endothelin A/endothelin B receptor antagonist, for the treatment of hypertension in combination with other drugs in patients whose BP is not adequately controlled on other drugs. Read more in Healio’s coverage of this approval.
Timing of BP medication may not matter
The timing of when a patient takes their BP medication does not appear to matter for reducing CV event risk, according to two trials and a meta-analysis presented at the 2024 European Society of Cardiology Congress.
“We found the benefits and risks of antihypertensive medications do not vary by the time of day that they are used,” Scott Garrison, MD, PhD, professor of medicine at the University of Alberta in Calgary, Canada, said during a press conference. “If you’re a physician, you don’t need to spend time promoting bedtime blood pressure medications. For the average person who has hypertension ... if you have a particular reason to want to take [medications] at a particular time, you are the best person to make judgment on when is the best time to take them.”
Read Healio’s coverage of this trial.
“What’s the best time? It’s the time of day in which the patient is going to consistently adhere to their medication,” Ferdinand said during the CMHC presentation.
Twice-yearly injectable antihypertensive drug
A single subcutaneous dose of zilebesiran (Alnylam), an investigational RNA interference agent, significantly reduced 24-hour mean ambulatory and office systolic BP at 6 months compared with placebo when added to other antihypertensive therapy.
Data from the phase 2 KARDIA-2 study were presented at the American College of Cardiology Scientific Session 2024. Read Healio’s in-depth coverage, with perspective.
Bariatric surgery vs. medical therapy
Ferdinand also highlighted the final 5-year data from the GATEWAY trial — the only randomized controlled trial to compare bariatric surgery with medical therapy for BP reduction, use of antihypertensive medications and hypertension remission in people with obesity.
At 5 years, 86% of adults with obesity who underwent Roux-en-Y gastric bypass surgery reduced their total antihypertensive medication burden by at least 30% compared with just 12.5% of adults who received antihypertensive medical therapy alone. Additionally, the change for hypertension remission 5 years after gastric bypass was nearly 20-fold higher than for those who received medical therapy alone.
Healio wrote about this trial and interviewed the lead researcher.
A new era for renal denervation
At the end of 2023, the FDA approved two renal denervation systems for the treatment of hypertension.
“Anytime we have a new device or pharmacotherapy agent for hypertension, I consider it a positive development for patients,” Ferdinand told Healio at the time of the approvals.
The Paradise ultrasound renal denervation system (ReCor) was the first renal denervation device approved to treat adults with hypertension not adequately controlled with lifestyle changes and medications. Read Healio’s coverage of this approval.
Soon after, the FDA approved the Symplicity radiofrequency renal denervation system (Medtronic). Read Healio’s coverage of this approval.
Results of the TARGET BP-1 trial, presented at the ACC Scientific Session, demonstrated a modest reduction in 24-hour ambulatory BP with alcohol-mediated renal nerve denervation using the Peregrine System Kit (Ablative Solutions).
“Although the systolic BP lowering was marginal, we look forward to data with perhaps a larger sample size and more rigorous BP lowering,” Ferdinand told Healio after the research was presented.
Click here to read Healio’s deeper coverage of the TARGET BP-1 trial.
These three renal denervation devices use different modalities to treat the renal nerves.
Ferdinand also highlighted a scientific statement from the American Heart Association, published in Hypertension in 2024, on renal denervation for the treatment of hypertension. According to the authors, “renal denervation presents a novel treatment strategy for patients with uncontrolled blood pressure,” but more research is needed, and studies assessing longer-term efficacy and safety are ongoing. The authors also emphasized the importance of multidisciplinary teams, adequately trained proceduralists and shared decision-making.
Intensive BP lowering
Ferdinand highlighted a study conducted in China that looked at whether intensive BP lowering would provide greater protection from CV events compared with a less-intense BP target. The ESPRIT study researchers reported that targeting systolic BP to less than 120 mm Hg reduced risk for CV and all-cause mortality over 3 years compared with less than 140 mm Hg among adults in China with hypertension.
The ESPRIT study builds on the knowledge gained from the SPRINT trial, Ferdinand told Healio at the time.
Building onto that knowledge, “I think we are very, very comfortable extending the idea that lower is better, including persons that have diabetes,” Ferdinand said during the CMHC presentation.
New strategies to lower BP
A recent study looked at safety and efficacy of a low-dose triple-pill protocol for lowering BP. Adults in Nigeria with uncontrolled hypertension who received a low-dose triple-pill protocol for 6 months had a 5.8 mm Hg reduction in home systolic BP compared with those who received standard care. Researchers also reported no increase in discontinuation due to adverse events. Healio reported on the VICTORIA trial, which was presented at the 2024 ESC Congress and published in JAMA.
“It takes a village to lower blood pressure,” Ferdinand said during the CMHC presentation.
References:
- Cluett JL, et al. Hypertension. 2024;doi:10.1161/HYP.0000000000000240.
- Liu J, et al. Lancet. 2024;doi:10.1016/S0140-6736(24)01028-6.
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Ferdinand KC. FDA Update and Late Breaking Trials. Presented at: Cardiometabolic Health Congress; Oct. 17-19, 2024; Boston.
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