High Blood Pressure
Understand and Prevent High Blood Pressure
(35) High Blood Pressure
Research and the future
Research into the causes, diagnosis and treatment of high BP continues on a large scale. For the most part research is led by academic institutions or pharmaceutical companies, often in collaboration
How is treatment of high BP likely to change over the next 10 years or so?
At present a great deal of investment in the different classes of BP-lowering drugs is being made by pharmaceutical companies. There are several thousand people recruited to randomized trials (where people are randomly allocated to receive one or other drug or a placebo, where the tablet contains no active ingredients at all), comparing older and newer BP-lowering drugs with the objective of establishing which, if any, is best.
This research is also being run in different people who have different risk factor profiles or other conditions. At present the main four classes of BP-lowering drugs (diuretics, beta-blockers, calcium-channel blockers and ACE inhibitors) are similar in effect. In fact, recent studies from North America have shown that the older BP-lowering drugs are as effective as the newer drugs for most people.
The most likely important change is the reclassification of primary high BP (‘essential hypertension’) from an apparently single category including all people with high BP of unknown cause, all treated in more or less the same way, into subgroups for which different causes are known, and therefore different treatments are most appropriate.
Are there likely to be any new developments in the genetic aspects of raised BP?
‘Genomics’ is the term given to the study of functions and interactions of the genes in the human genome. There is great interest in linking the function of genes to disease and physiological mechanisms and eventually to effective drug treatments. For instance the renin–angiotensin system and autonomic nervous system are known to play a role in the development of high BP. Scientists are trying to find a genetic link in the hope that drug treatments can be ‘tailored’ to people with a specific genetic make-up.
I like to surf the net. Is the internet likely to influence research into high BP?
The internet is being increasingly used for dissemination of information about high BP. There are many internet sites that provide information for people with high BP.
It is possible that in the future the patient registers in general practices and hospital clinics may be linked through ‘managed clinical networks’ on the internet. There are several successful examples in diabetes care. The advantage is that all relevant medications and investigations will be available irrespective of where you may be seen, and communication between health professionals is improved.
Ultimately, we will all have an individual electronic health record, that can be accessed through a secure internet connection, allowing access to laboratory investigations and medication records, irrespective of the site of care – in your doctors surgery or in a hospital clinic.
How is this likely to change the management of hypertension?
It is likely that prevention of stroke or heart attack will become the starting point and that all risk factors – age, sex, cholesterol, weight, smoking, diet and previous past medical history – will be considered simultaneously. It is also likely that drug treatment will become more ‘tailored’ to suit the particular risk factor profile of each person.