New Class of Anti-hypertensive Drugs May Better Protect Patients from Developing Cardiovascular and Renal Disease Caused by Hypertension

Dubai, United Arab Emirates: As many as 44 percent of patients admitted to hospital in Dubai with a heart attack suffer from high blood pressure, underscoring the high risk untreated hypertension presents in developing cardiovascular disease.

The new data, gathered by doctors at Dubai Hospital's Cardiac Centre, also shows that patients diagnosed with hypertension are three times more likely to suffer from heart failure – a long-term condition where the heart muscle stops pumping blood around the body effectively – which is one of the most common causes of hospital admission in the UAE.

Around 500 delegates attending Heart Failure Dubai 2010, run by Dubai Health Authority in association with the Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences and the Emirates Cardiac Society, will hear how treating hypertension with lifestyle changes and the most up-to-date medications, such as direct rennin inhibitors (DRIs), can dramatically reduce the chances of developing cardiovascular and renal disease.

“The high number of patients admitted to our cardiac centre with heart attack and heart failure who suffer from high blood pressure is a strong indicator of how serious the condition is,” said Dr. Nooshin Bazargani, a cardiologist at Dubai Hospital, and Chairman of the Scientific Committee of Heart Failure Dubai 2010. “People with high blood pressure have an increased risk of developing cardiovascular disease, which includes heart attack, heart failure, and stroke, as well as renal disease, which are all life threatening. Our data suggests that awareness of the disease in the UAE is low, and that we need to better educate both the public and healthcare professionals in ways to prevent and treat high blood pressure,” she added.

Hypertension affects one in four globally and has been dubbed the “silent killer” because sufferers rarely feel any symptoms. A normal blood pressure is 120/80 mmHg, according to global recommendations. “In many patients hypertension can be effectively controlled using anti-hypertensive medications and initiating lifestyle changes, which involves keeping body weight within normal limits through a healthy diet that's low in salt, and by exercising regularly,” explained Dr. Bazargani.

“The good news is that if you reduce your blood pressure by 10/5 mmHg, you will reduce your risk of having a heart attack by 15 percent, the risk of heart failure by 50 per cent, the risk of stroke by 38 percent, and the risk of death by 10 percent,” Dr. Bazargaani added. Advancements in anti-hypertensive medications have been made in recent years with the advent of DRIs, which work in a different way to the five traditional types of blood pressure drugs, and can be used alone or in combination therapy. DRIs have been shown to give effective blood pressure control in difficult to treat groups, such as the elderly [1], [2], [3], as well as possibly offering increased protection from organ damage caused by hypertension [4], [5], especially kidney damage in those with hypertension who suffer from obesity-related diabetes.

DRIs work by blocking the enzyme renin from triggering the process called the renin-angiotensin system (RAS system), which helps regulate blood pressure – older drugs block angiotensin. As a result, blood vessels relax and widen, making it easier for blood to flow through the vessels, which lowers blood pressure.

Professor Hans-Henrik Parving, a world-renown expert on the treatment of hypertension in diabetes, who gave a lecture on DRIs at the conference, said: “The RAS-targetting approach has been shown in older drug classes, which work by blocking angiotensin, to effectively lower blood pressure and offer protection against heart and renal disease.” ‘However, we believe that this new DRI class that impacts on renin instead of angiotensin, could offer further additional clinical advantages in terms of protecting patients from cardiovascular and renal disease associated with hypertension,” explained Professor Parving, who is Chief Physician Professor in the Department of Medical Endocrinology at the University of Copenhagen, Denmark.

“DRIs are an innovative treatment for hypertension, and look very promising, especially in managing difficult-to-treat patients who may require two or three medications to control their blood pressure. We need more experience and data on how this new class of drug works in specific groups, especially feed-back from patients” added Dr. Bazargaani. DRIs have been available on prescription in the UAE at private hospitals since February 2009, and are expected to be approved by the Ministry for Health for inclusion on the drug formulary for government-funded healthcare facilities in the coming year.

Heart Failure Dubai 2010 is running from February 18- 20 at the Intercontinental Hotel in Dubai, and is supported by the European Cardiology Society. ENDS Research: [1] Yarows S, Oparil S, Patel S, et al. Aliskiren in Combination with Valsartan Provides Additional Blood Pressure Lowering Effects Compared with Either Agent Alone in Elderly and Younger Patients with Hypertension. Poster presented at Hypertension 2008, Berlin. [2] Schmieder R, Philipp T, Guerediaga J, et al. Long-Term Aliskiren-Based Therapy Effectively Lowers Systolic Blood Pressure and Pulse Pressure in Elderly and Very Elderly Patients with Hypertension. P

oster presented at Hypertension 2008, Berlin. [3] Uresin Y, Taylor AA, Kilo C et al. Aliskiren Monotherapy Lowers Blood Pressure More Effectively Than Ramipril Monotherapy in Patients with Diabetes and Grade 2 Hypertension: Subgroup Analysis of an 8-Week, Double-blind Trial.

Poster Presented at Hypertension 2008, Berlin. [4] Müller D, Luft F. Direct Renin Inhibition with Aliskiren in Hypertension and Target Organ Damage. Clin J Am Soc of Nephrol. March 2006:1(2): 221-228. [5] Shafiq MM, Menon DV, Victor RG. Oral Direct Inhibition: Premise, Promise, and Potential Limitations of a New Antihypertensive Drug. Am J Med. 2008 Apr;121(4):265-71.