Blood Pressure Potpourri

Volume 2, Issue 2

“…pressure…pushing down on me, pressing down on you…”

Under Pressure is certainly as true today as ever, as hypertension continues to inflict a ghastly toll on the adult American population. Using the most recent 2017 definition, the age-adjusted prevalence of hypertension among US adults over 20 years of age was estimated to be 46.0% in NHANES in 2013 to 2016. This equates to an estimated 116.4 million adults ≥20 years of age who have high blood pressure (HBP) (58.7 million men and 57.7 million women). The SPRINT trial data conclusively showed that lower BP targets are essential in reducing the morbidity and mortality associated with hypertension. When combining the high prevalence of hypertension with the new aggressive treatment targets, we get a recipe for a lot of patients to be taking a lot of drugs. In this week’s issue of Talking Therapeutics, we look at a few recent and interesting articles surrounding this timely topic.

Talking Point: Avoid Beta-Blockers for Patients With HIV

Beta-blockers have largely fallen out of favor for managing essential hypertension in the general population given their inferior outcomes (ie higher rate of ischemic stroke). As patients with HIV are living normal lifespans due to HAART therapy, incident rates of CVD have risen in this patient population. The pathophysiology of HTN/CVD is unique in patients with HIV, which raises the question if differences in outcomes between antihypertensive medications exist for these patients. A recent study published in Hypertension sought to address this question through a retrospective review of 8,000 veterans. This study found that similar to the general population, HIV patients prescribed beta-blockers had a higher rate of CVD events. Interesting, those on ACE inhibitors had slightly lower CVD event rates. In light of these findings, beta-blockers should not be used to manage essential hypertension in patients with HIV.

Point 2: No Risk of Cancer With Antihypertensive Agents

Some studies have suggested a link between antihypertensive medication and cancer, but the evidence is so far inconclusive. Recently a high-quality meta-analysis of 33 studies involving over 250,000 patients was published in Lancet Oncology. In the individual participant data meta-analysis comparing each drug class with all other comparators, no associations were identified between any antihypertensive drug class and risk of any cancer with the exception of a very slight signal in calcium channel blockers (1·06 [1·01–1·11]). Overall these reassuring findings can all but entirely rule out a risk of cancer for most antihypertensive agents, with the exception of calcium channel blockers. 

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