ESC TV 2015 – Congress by Topic – Hypertension

PATHWAY is a series of trials conducted by the British Hypertension Society investigating the treatment of
hypertension, in PATHWAY-2 314 well-characterized
resistant hypertensive patients were randomised to receive, in a sequential
manner, either spironolactone, an alpha blocker a beta blocker or a placebo, every
patient took every drug for 12 weeks We saw that the best drug for most patients, almost every patient, was spironolactone, low-dose 25, 50 milligrams a day, vastly superior to placebo and highly significantly superior to the other blood pressure lowering treatments The summary of the study is that the potassium-sparing diuretic amiloride is as effective at lowering blood pressure as hydrochlorothiazide but has the advantage of preventing any glucose intolerance and when the two drugs are
used together we have a win-win, where all the benefits of the two drugs are amplified in lowering blood pressure and their undesirable effects are cancelled out Baroreceptor stimulation is an interesting new approach in the treatment of resistant hypertension the figures are quite good actually, but there is only a limited experience so there is not so thousands of patients, today we have about 500 patients treated with this approach but the results show that once you stimulate the baroreceptors you can have a significant decrease in blood pressure which are sustained over years, but now we have an experience of about 4 or 5 years safety, it appears to be relatively safe in the small numbers of patients we have the only complication that has been observed is the narrowing of the carotid artery and this had occurred in about 3 % of patients at 2 years

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