Hypertension comorbidities’ link studied

MANILA, Philippines - It is well known that hypertension is not an isolated cardiovascular disorder and usually presents with several comorbidities. Hence, several authors have called it the “Hypertension Syndrome.”

Clinicians frequently encounter a dilemma piecing together the multi-organ involvement present, so patients with elevated blood pressure can be treated holistically.

The Philippine Heart Association (PHA), in collaboration with Novartis Healthcare Philippines Inc., recently organized a symposium uncovering the links between hypertension, chronic kidney disease, Alzheimer’s disease, and diabetes mellitus.

The conference, dubbed “Hypertension Link: Managing Risks and Complications,” gathered local authorities in cardiology who all generously shared their knowledge and expertise on the subject.

“This meeting seeks a deeper understanding of hypertension and its comorbidities. With the knowledge gained from this CME activity, we expect to address the hypertension burden better and manage the potential complications as well,” Dr. Saturnino Javier, PHA president, said in his opening remarks.

Topics in the conference included “Hypertension and Kidney Diseases: Purely RAAS Business?” by Dr. Lynn Gomez, FPSN; “Hypertension and Alzheimer’s Disease: Is There a Link?” by Dr. Carlos Chua, FPNA; and “RAAS and Insulin Link: Does It Exist?” by Dr. Roberto Mirasol, FPSEM.

Gomez discussed the role of albuminuria as an accurate predictor of potential cardiovascular events and mortality independent of the blood pressure. Albuminuria is also part of how chronic kidney disease can be graded.

“Albuminuria in the urine is an indication of kidney disease and signals that the person may suffer a cardiovascular event (in the future),” she said.

When hypertension and albuminuria co-exist, treatment guidelines recommend that hypertension be aggressively treated to levels < 130/80 mm Hg. RAAS blockade should be the mainstay of treatment either with ACE inhibitors or an angiotensin receptor blocker, according to Gomez.

“In the absence of albuminuria, blood pressure reduction with any anti-hypertensive agent… is the key to prevention. Treating hypertensive patients with CKD is not purely RAAS business,” she said.

Meanwhile, midlife hypertension can be a predictor of Alzheimer’s disease, according to Chua. For patients over 65 years old, blood pressure of >180 mmHg can also be a predictor of Alzheimer’s disease.

He added that hypertension can be prevented using conventional drugs to reduce the risk of Alzheimer’s disease.

While no agent is recommended, adequate treatment of blood pressure is advised but it should not be lower than the recommended level. Chua said agents that demonstrated risk reduction of Alzheimer’s disease are ACE-I, ARBs, CCB, and diuretics.

There is also a significant connection between hypertension and dysglycemia, according to Mirasol. The major players for hypertension in this case are the RAAS and sodium. The role of the sympathetic nervous system — though significant — is only secondary, he said.

Mirasol added that RAAS hyperactivity leads to insulin resistance and hyperglycemia, which can eventually evolve to full-blown diabetes mellitus. He explained that by blocking the RAAS, diabetes can be delayed or prevented.

“Many studies showed that there is no evidence that targeting BP to less than 130/80 is not beneficial. However, the guidelines remain unchanged since the evidence is still weak to recommend allowing permissive hypertension,” he said.

“We’d like to thank the Philippine Heart Association for another meaningful partnership. Congratulations for the solid commitment to give heart and saving lives — this is very much aligned with our thrust as a company. In Novartis, our purpose is to care and cure the patient,” said Josephine Anne Elicano, Novartis senior brand manager.