Hypertension

The renin angiotensin system (RAS)

What is the RAS, how does it influence blood pressure, and what is its role in organ damage and disease?

The role of RAS in hypertension (HTN)

The angiotensin II type 1 (AT1) receptor facilitates a variety of physiological effects in key organs. Sustained activation can lead to damage, and antihypertensives can have a protective function.

RAS: its role in HTN and cardiovascular (CV) disease

Professor Weizhong Zhang discusses the pathophysiological effects of angiotensin II.

RAS inhibition and organ protection

Inhibition of the RAS affords CV and renal protection. Professor Zhang explores specific mechanisms of action.

Are RAS blockers of benefit to patients with diabetes?

There is a close relationship between diabetes and hypertension. In this animation, the benefits of effective HTN management in patients with diabetes are reviewed.

Is there a role for RAS blockers in patients with kidney disease?

Explore underlying data and review the impact ARBs can have in patients with nephropathy.

Why renin angiotensin aldosterone system (RAAS) blockers are a foundation antihypertensive therapy

With several drug classes available to treat hypertension, why are renin-angiotensin-aldosterone system (RAAS) blockers considered to be so important? Professor Bryan Williams highlights their benefit.

The merits of angiotensin receptor blockers (ARBs) over angiotensin converting enzyme inhibitors (ACEIs)

When selecting an antihypertensive, relative merits of ARBs over ACEIs centre around achieving optimal outcomes.

Is there evidence for combining ARBs and ACEIs?

Regarding up-to-date guidelines, explore the VALIANT study data that underpin why combining ARBs with ACEIs is not recommended.

Angiotensin receptor blockers (ARBs) versus angiotensin converting enzyme inhibitors (ACEIs): duration of action

What is the difference in duration of action between ARBs and ACEIs, and how can it be measured? Professor Williams provides clarity.

ARBs versus ACEIs: cardiovascular outcomes

Is there a difference between these treatments in relation to cardiovascular outcomes? The latest meta-analysis is explored. Professor Williams goes on to explain how we can investigate such differences.

ARBs versus ACEIs: tolerability and persistence

The benefit of ARBs in relation to tolerability has an important relationship with patient adherence. How might this impact upon comparative outcomes between ARBs and ACEIs?

Perspectives on ARBs and ACEIs

Professor Williams summarises the importance of therapeutic blockade of the RAAS in relation to treating blood pressure, preventing organ damage, and protecting against cardiovascular and renal events. He concludes with rationale for the preferred use of ARBs.

Calcium channel blockers (CCBs): mechanism of action

CCBs and Angiotensin Receptor Blockers (ARBs) both promote vasodilation. But how are they distinct? Professor Luis Ruilope goes on to talk about their actions in reducing peripheral resistance and arterial stiffness, lowering albuminuria and the corresponding impact on blood pressure.

Combining CCBs and ARBs

Professor Ruilope explores evidence from the VALUE and ACCOMPLISH studies, as well as data from Gradman et al. for use of combination treatment in the form of ARBs and CCBs, as well as angiotensin converting enzyme inhibitors (ACEIs) and diuretics.

Cardiovascular and renal system benefits of combining CCBs and ARBs

Is there simultaneous cardiovascular and renal protection from CCB and ARB combination treatment? As we explore this topic with Professor Ruilope, he provides an evidence-based conclusion.

Calcium channel blockers (CCBs) versus angiotensin receptor blockers (ARBs): efficacy

Key outcomes from the VALUE study are highlighted as we consider the relative benefits of CCBs and ARBs in relation to a range of cardiovascular sequalae. Following this, we look at the rationale for use of an ARB in hypertension-free individuals as a way to prevent its progression.

CCBs versus ARBs: tolerability

Explore the tolerability of CCBs and ARBs as individual treatments in addition to the effect seen when they are combined.

Role of combination therapy in hypertension

Professor Rainer Düsing highlights the number of drugs required for hypertensive control across numerous intervention studies and considers a ‘rule of thirds’ in relation to combination therapy across a large patient population.

Why do patients need a combination therapy?

Professor Düsing addresses why so many patients require more than one antihypertensive therapy, highlighting a large meta-analysis across drug classes to demonstrate limitations in individual agents’ efficacy, even when antihypertensive doses are doubled.

Challenges of combination therapy as separate pills

Here we consider the problem of adherence when offering combined therapy as separate pills and highlight the scale of the issue. The need for regimen simplicity is supported by the meta-analyses discussed.

Single-pill combinations and tolerability

Is there a difference in adverse events related to number of pills taken? There may be a psychological effect to consider, but statistically we see the evidence is clear.

Why is there a need for early targeted therapy in hypertension?

The global picture is highlighted as we consider risk of secondary cardiovascular events and how timely control of hypertension can improve outcomes. Find key takeaways from guidelines, including the benefit of fixed-dose combinations.

Are there any advantages to single-pill combinations over free-drug combinations?

Guideline statements and data to support the need for multiple agents to gain blood pressure control are referenced as we look at the close association between single pill combinations and optimum treatment.

How does valsartan perform in the real-world?

Do clinical trial data translate to real-world benefit seen for use of valsartan in patients with hypertension? Real-world studies provide important information including in relation to treatment efficacy, co-morbidities and adverse events.

The story of hypertension and COVID

Explore clinical evidence on the safety of ACE inhibitor and ARB use in COVID-19 patients with hypertension; gain practical advice from the guidelines.

Hypertension update: use of ACEIs and ARBs in the context of COVID-19

The COVID-19 pandemic has required scientists, clinicians and patients to review data which is rapidly updating and evolving. Understanding if COVID-19 may affect the treatment of hypertension offers benefit in relation to decisions about effective drug therapy, and the data presented here are based on recommendations and statements from global medical and scientific societies.

• Find key information related to drug therapy for hypertension in the context of COVID-19
• Gain clarity regarding situations in which angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) might require discontinuation, based on clinical picture and not directed by COVID-19 status
• Ensure that the rationale for initiating treatment for hypertension is well-understood

2018 European Society of Cardiology (ESC) / European Society of Hypertension (ESH) guidelines

Globally, what proportion of people are receiving treatment for hypertension and have their blood pressure under control? Guideline updates are designed to address the complexities of how to improve the ability of patients and clinicians to meet therapeutic targets.