Innovative approach to high blood pressure treatment

Are you currently being treated for high blood pressure? If you are, it might alarm you to know that the results of blood pressure treatment programs worldwide are not very good despite all available drugs in the antihypertensive armamentarium.

In the United States (the country with the most available resources for health care), a 1997 report prepared by an expert committee stated that among people with high blood pressure, only 68 percent were aware they had such a condition and only 53 percent were receiving medical treatment.

Most alarming of all, only about 27 percent had blood pressure levels successfully reduced to appropriate levels, thus still exposing the majority of hypertensives to the dangerous complications of high blood pressure such as heart attacks, brain attacks (commonly called strokes) and irreversible kidney damage which may lead to life-long dialysis or kidney transplantation.

The latest data from 2001 continue to show the same poor performance of blood pressure control in the US, and more so in the Philippines (as with other Third World countries), where the statistics are expectedly worse.

What could be the reasons for such poor performance? Lack of funding is obviously not the problem, or else the US statistics would be much better than they are now. Medical specialists appear to agree on several reasons.

Compliance

The first reason is a problem of compliance – patients simply fail to take their medicine, either completely or may miss one or more of several doses in a given day. Reasons for this include forgetfulness, annoying side-effects, and a perception that the medicine is not working, due to persistently high blood pressure readings.

Secondly, in an effort to lower blood pressure to meet the new, stricter requirements (less than 130/80 in diabetics and less than 125/75 in patients with kidney damage), doctors may increase drug dosages to the point of seriously interfering with the patient’s quality of life.

Common complaints about blood pressure treatments at higher doses include tiredness, drowsiness, impotence, cough, dizziness, flushing and edema, just to name a few. As a result, dosages may be lowered, patients remain underdosed, and the blood pressure remains uncontrolled.

A third reason is that more than one mechanism may be responsible for the elevated blood pressure (genetics, stress, excessive salt intake, inherent kidney problems, overly excitable heart and blood vessels, hormonal problems, etc.), such that a single medicine may be unable to cope.

Thus, more effective blood pressure treatments must address the problems of compliance and proper dosages, yet with a minimum of side-effects. The multiple mechanisms causing blood-pressure elevation must also be considered.

VLDC approach

Hypertension scientists are exploring various treatment approaches that could possibly address all of the pressing concerns. Medical experts both here and abroad believe that one new innovative approach is the so-called VLDC (Very Low-Dose Combination), which seeks to optimize blood pressure treatment by combining very low doses of two additive and complimentary drugs in a single, once-a-day pill.

Once-a-day dosing has been proven to improve compliance, while the very low doses of the two additive components target different blood pressure elevation mechanisms, ensuring maximum effectivity yet with very few side-effects.

Does the VLDC concept work in Filipinos? The only VLDC blood pressure drug available in the country today is called Preterax, a combination of very low doses of the drugs perindopril and indapamide, two effective blood pressure-lowering agents in their own right when used alone at their normal doses.

Preliminary results of a study among Filipino hypertensives with blood pressures ranging from 140/90 to 180/110, treated with once-daily Preterax for 12 weeks, showed they had successfully reduced blood pressure by 20/10 mm Hg in 95 percent of cases, and actually normalized readings in 89 percent.

Preterax is the first-ever VLDC drug worldwide developed for high blood pressure, and is the product of extensive research and development by Les Laboratories Server, represented in the country by Servier Phils.

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(CHARTER is the acronym for Clinical Hypertension and Atherosclerosis Research on Therapies, Epidemiology and Risk-management, a non-stock, non-profit research foundation which promotes healthy lifestyle changes and rational treatment options in the prevention of many common medical problems. It is based at the Manila Adventist Medical Center. Free membership is open to health-conscious medical, paramedical and lay individuals. For an archive of health-related topics and to register as a member, log on to www.chartermamc.org.)