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over 90mmHg diagnostic threshold Division of Nephrology and
9 for hypertension. Meanwhile, Hypertension at the Groote Schuur
reports in the prestigious Lancet Hospital and University of Cape
and the British Medical journals Town, said a three-pill regimen
“Our problem is that world-wide differ over the BP targets would address huge unmet
we don’t know what the best recommended. needs in South Africa and the
combinations are. We know that continent. He said up to 90% of
patients need at least two drugs, What guidelines in the world tend to hypertensive South African patients
sometimes three ideally in a single agree on, he said, was that treating remain untreated and agreed with
pill for the best outcomes. A single with two drugs as initial therapy Prof Poulter that the American
(combination drug) pill gives more was the way to go. Just two drugs guidelines, “have set us back and
effective and rapid BP control than in a single tablet already improved created confusion in the definition
monotherapy and two “free” drugs. compliance by 21%. If a patient of hypertension – there’s a big
You get reduced side-effects, was above a certain level of risk difference between a target and the
enhanced adherence, improved they should also be on a statin, definition,” he added.
cardiovascular protection and regardless of cholesterol levels -
they’re more cost-effective,” said at least until 80 years of age, he References:
Prof Poulter. added. Ref 1. Poulter, NR et al. The
Lancet; published March 29th,
Prof Poulter has just completed a Prof Poulter’s conclusions from the 2015. Hypertension. https://www.
major trial of three different two- ACE inhibitors vs ARB controversy thelancet.com/journals/lancet/
drug combinations for lowering BP in managing hypertension are article/PIIS0140-6736(14)61468-9/
in Black Africans in six sub-Saharan that individual trial data and meta- fulltext. Last Accessed October
countries, (the CREOLE study), analyses are relatively consistent 2018.
with definitive but yet-to-be-released in showing the superiority of ACE
results. He said he hopes to present inhibitors. ARB’s are better tolerated Refs 2&4. Chow CK1, Teo KK,
them “somewhere prestigious,” but do not reduce mortality or Rangarajan S, Islam S et al.
early next year. cardiac events as well as ACE JAMA. 2013 Sep 4;310(9):959-68.
inhibitors and should be used if doi: 10.1001/jama.2013.184182.
“We now know what works for Black patients cough on ACE-inhibitors. Prevalence, awareness, treatment,
Africans – our primary end-point Prof Poulter concluded his and control of hypertension in rural
was to lower ambulatory systolic presentations with a telling cartoon and urban communities in high-,
BP after six months,” he revealed, of an obese man, with a frothy pint middle-, and low-income countries.
while keeping tight-lipped about the of beer in one hand and a cigarette https://www.ncbi.nim.hih.gov/
much-anticipated findings. butt in his mouth, sticking his hand pubmed/24002282. Last Accessed
through a hole in a wall on the other October 2018
Clearing up muddy treatment side of which an unseeing doctor
waters measures his BP and puts pills in Ref 3. Dena Ettehad, Connor A
an outstretched palm. Emdin, Amit Kiran et al. The Lancet,
In two slightly differing Vol 387 March 5, 2016, Blood
presentations to the Cape Town Session moderator, Professor pressure lowering for prevention
global internal medicine congress, Sajidah Khan, an interventional of cardiovascular disease and
Prof Poulter reviewed existing cardiologist at the Gateway Private death: a systematic review and
combination drug trials and decried Hospital in Umhlanga, said that in meta-analysis. https://www.
the American lower treatment the very country that most funds thelancet.com/journals/lancet/
threshold BP guideline of 130mmHg prevention (North America), the article/PIIS0140-6736(15)01225-
over 80mmHg. He said that sale of ultra-processed foods 8/fulltext?code=lancet-site. Last
although the SPRINT study which this year rose by 2,3% compared Accessed October 2018.
influenced this lower threshold to a 71% increase in Africa and
had reported lower rates of fatal Eastern countries. Simultaneously, Ref 5: Thomas Beaney, Aletta
and non-fatal major cardiovascular the revenue growth for the world E Schutte, JAMA. 2013 Sep
events from any cause, at systolic biggest tobacco retailer, Philip 4;310(9):959-68. doi: 10.1001/
BP targeted to <120 mmHg the Morris, rose by 2,8%. It was jama.2013.184182. May
Americans measured BP, “in a way thus unsurprising that 80% of all Measurement Month 2017:
nobody does in this room – they cardiovascular disease occur in an analysis of blood pressure
used a machine with the patient lower to middle-income countries. screening results worldwide.
alone in a back room which gives The damaging myths about statins https://www.thelancet.com/
lower BPs than those measured paled by comparison to this. pdfs/journals/langlo/PIIS2214-
in your clinics.” He recommends 109X(18)30259-6.pdf. Last
sticking with the higher 140mmHg Prof Brian Rayner, Head of the Accessed October 2018.
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