Stroke and renal failure is linked to SBP which needs multiple drugs to control-Prof. Javed Akram


 Challenges in SBP Control

Stroke and renal failure is linked to SBP which
needs multiple drugs to control-Prof. Javed Akram

LAHORE: Two out of every three people over the age of sixty five years suffer from hypertension. Systolic blood pressure increase with age. When arteries become still, the blood velocity increases. At present only one out of ten people suffering from hypertension have achieved their blood pressure control which is the lowest figure. This was stated by Prof. Javed Akram Vice Chancellor of University of Health Sciences. He was speaking on Challenges in Systolic Blood Pressure Control at a meeting organized by Servier Pharmaceuticals in collaboration with Pakistan Academy of Family Physicians at a local hotel here on September 6th 2018. It was very well attended by the Family Physicians members of the PAFPs.

General Practitioners Prof. Javed Akram further stated can play an important role in control of hypertension. In UK the authorities have involved the GPs with the result that 21% of their patients suffering from high blood pressure have now achieved their BP control. In Pakistan we have about twenty million people who suffer from hypertension. Ten million are not aware of this, five million are aware of it and are not under treatment but only three million are getting treatment. SBP is difficult to control. IHD and CVD are related to diastolic blood pressure. High blood pressure early in the morning and between 7-10 PM are very dangerous, hence we need to use those antihypertensive which ensure twenty four hour blood pressure control and for this one needs more than one drug.

Speaking about drug treatment, Prof. Javed Akram said that studies have now shown that amlodipine is much better than atenolol. Beta blockers have now been downgraded to the fourth line of drug therapy. Atenolol is also chromogenic which could lead to stroke. SPRINT study was stopped just after three and a half years because of overwhelming response in primary outcome. It also showed that aggressive therapy should be preferred and there is no harm. ADVANCE study showed that lowest the blood pressure the better but it should not be so low as to bring harm. SPRINT study also showed that combination therapy was very effective in patients fifty years of age and above with one risk factor. NATIVE study showed that Natrilix SR 1.5 mg resulted in significant reduction of blood pressure just after three months with the addition of an inexpensive diuretic.  It also lowered the chances of stroke. Thiazide type diuretics are considered much better. After eighty years of age, there was significant reduction in stroke.  LVH reduction was much better by Indipamide SR. Prof. Javed Akram further stated that every person suffering from hypertension should be on low dose Aspirin therapy provided there are no contra indications but it should be started once the blood pressure has been brought under control. Use of low dose statins also helps in reduction of morbidity and mortality. The latest recommendations are that even in case of surgery one should not stop low dose Aspirin therapy but if the patient is on dual antiplatelet therapy, one should stop clopidogrel but continue with Aspirin, he added.