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… continued from page 20
Meanwhile, reports in the prestigious
Lancet
and
British
Medical Journal
differ over the BP targets recommended.
What guidelines in the world tend to agree on, he said, was
that treating with two drugs as initial therapy was the way
to go. Just two drugs in a single tablet has already improved
compliance by 21%. If a patient was above a certain level of
risk, they should also be on a statin, regardless of cholesterol
levels, until at least 80 years of age, he added.
Prof Poulter’s conclusions fromtheACE inhibitors vsARB
controversy in managing hypertension are that individual
trial data and meta-analyses are relatively consistent in
showing the superiority of ACE inhibitors. ARBs are better
tolerated but do not reduce mortality rate or cardiac events as
well as ACE inhibitors and should be used if patients cough
on ACE inhibitors. Prof Poulter concluded his presentation
with a telling cartoon of an obese man, with a frothy pint of
beer in one hand and a cigarette butt in his mouth, sticking
his hand through a hole in a wall, on the other side of which,
an unseeing doctor measures his BP and puts pills in an
outstretched palm.
Session moderator, Prof Sajidah Khan, an interventional
cardiologist at the Gateway Private Hospital in Umhlanga,
said that in the very country that most funds prevention
(North America), the sale of ultra-processed foods this year
rose by 2.3% compared to a 71% increase in Africa and
Eastern countries. Simultaneously, the revenue growth for the
world’s biggest tobacco retailer, Philip Morris, rose by 2.8%.
It was therefore unsurprising that 80% of all cardiovascular
disease occurs in lower- to middle-income countries. The
damaging myths about statins paled by comparison with this.
Prof Brian Rayner, head of the Division of Nephrology
and Hypertension at the Groote Schuur Hospital and
University of Cape Town, said a three-pill regimen would
address huge unmet needs in South Africa and the continent.
He said up to 90% of hypertensive South African patients
remain untreated and agreed with Prof Poulter that the
American guidelines, ‘have set us back and created confusion
in the definition of hypertension – there’s a big difference
between a target and the definition,’ he added.
1.
Poulter NR, Prabhakaran D, Caulfield M,
et al
. Hypertension.
Lance
t 2015;
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(9995): 801–812.
2.
Chow CK, Teo KK, Rangarajan S, Islam S,
et al.
Prevalence, aware-
ness, treatment, and control of hypertension in rural and urban
communities in high-, middle-, and low-income countries
. J Am
Med Assoc
2013;
310
(9): 959–968.
3.
Dena Ettehad, Connor A Emdin, Amit Kiran et al. Blood pres-
sure lowering for prevention of cardiovascular disease and death:
a systematic review and meta-analysis.
Lancet
2016;
387
(10022):
957–967.
4.
Beaney T, Schutte AE, Tomaszewski M,
et al
.
May Measurement
Month 2017: an analysis of blood pressure screening results world-
wide.
Lancet Glob Health
2018;
6
(7): e736–743.