Hypertension

Panelists discuss how improving adherence requires both individual strategies like smartphone reminders and smart medication monitoring devices, as well as population-level interventions including reducing sodium content in processed foods and harmonizing hypertension guidelines to address the epidemic of poorly controlled blood pressure.

Panelists discuss how newer therapies will likely be incorporated into guidelines with improved reimbursement structures over time, similar to the evolution seen with lipid-lowering medications, making advanced treatments more accessible for patients with uncontrolled blood pressure.

Over 11,000 bottles have been voluntarily recalled in response to a consumer complaint of a foreign substance inside a tablet, later identified as aluminum.

July delivered 9 impactful advancements across the gamut of disciplines in cardiology.

Panelists discuss how follow-up strategies should include monthly visits initially with more frequent monitoring for high-risk situations, emphasizing home blood pressure monitoring and utilizing team-based care approaches with optimal visit intervals of 4 to 6 weeks to avoid both therapeutic inertia and overadjustment.

Panelists discuss how shared decision-making requires explaining the rationale for blood pressure control, addressing patient fears about medications, and utilizing newer drug classes like endothelin receptor antagonists that offer a “clean slate” approach for patients who have had negative experiences with traditional therapies.

A panelist discusses the importance of comprehensive patient reassessment before advancing to dual endothelin receptor antagonists or aldosterone antagonists, emphasizing that successful resistant hypertension management requires integration of advanced pharmacological therapies with lifestyle interventions and ongoing patient support.

Panelists discuss how medication reduction is occasionally possible in well-controlled patients over time, particularly with diuretics when sodium intake decreases or calcium channel blockers to reduce edema, while being cautious about maintaining adequate blood pressure control and avoiding drugs that worsen kidney function.

Panelists discuss how aggressive blood pressure targets below 130 mm Hg (preferably 120 mm Hg) should be pursued in most resistant hypertension patients using combination therapies, while individualizing goals based on patient age, tolerability, and comorbidities.

A panelist discusses real-world clinical experience with aprocitentan showing remarkable blood pressure improvements in heavily pretreated patients, with manageable side effects like mild fluid retention that can be addressed through diuretic adjustments.

Panelists discuss how to sequence fourth-line treatments for resistant hypertension, with spironolactone remaining first choice for most patients with normal renal function, while newer endothelin receptor antagonists offer advantages for patients with chronic kidney disease or those intolerant to aldosterone antagonists.

Panelists discuss how the PRECISION trial subanalysis showed aprocitentan worked equally well in Black patients as in White patients, which is particularly important given the higher prevalence and complications of resistant hypertension in Black populations, with emphasis on adequate diuretic management to prevent peripheral edema.

An audio recap of the top 5 stories in healthcare news from the week of 07/07-07/13.

A panelist discusses how aprocitentan, a dual endothelin receptor antagonist, represents a breakthrough treatment that blocks both A and B receptors to achieve clinically meaningful blood pressure reductions in resistant hypertension patients.

Panelists discuss how the PRECISION trial demonstrated aprocitentan’s efficacy in lowering blood pressure by nearly 15 mm Hg within 4 weeks in resistant hypertension patients, including those with advanced chronic kidney disease, with durable effects and minimal adverse effects except for manageable peripheral edema.

Panelists discuss how endothelin receptor antagonism addresses resistant hypertension by blocking one of the most potent vasoconstrictors, reducing smooth muscle hypertrophy and fibrosis, with aprocitentan being the only endothelin receptor antagonist approved for resistant hypertension.

BaxHTN trial results showed baxdrostat led to a significant reduction of systolic blood pressure compared to placebo, with a favorable safety profile.

Treatment with baxdrostat resolved or reduced the severity of hypertension, excessive aldosterone production, and hypokalemia in the phase 2a SPARK trial.

A panelist discusses how healthcare providers must become lifestyle coaches who understand patients' daily routines and circumstances to develop realistic medication schedules that address practical barriers to adherence in complex polypharmacy regimens.

Panelists discuss how standard ACE therapy leaves multiple pathways unblocked in resistant hypertension, with spironolactone being the most evidence-based fourth-line therapy despite limitations, while emerging therapies target sympathetic nervous system overactivity, aldosterone excess, and endothelin-mediated vasoconstriction.

Panelists discuss how lifestyle modifications, particularly sodium restriction and plant-based diets, form the foundation of resistant hypertension management, with innovative approaches like teaching kitchens and food-as-medicine programs being more effective than traditional diet counseling.

A panelist discusses how treatment strategies progress from standard 3-drug regimens (thiazide diuretics, calcium channel blockers, and ACE inhibitors/ARBs) to fourth-line options like endothelin antagonists or aldosterone antagonists, while addressing information overload and the need for weight management drugs.

Our June 2025 recap highlights significant advancements in cardiology, including new drug approvals and pivotal trial results.

The results of the ZENITH trial have encouraged the expansion of sotatercept’s label to patients with prior background therapy.

Panelists discuss how patients with resistant hypertension should be referred to specialists after 3 to 6 months of unsuccessful treatment, emphasizing that while primary care providers can manage most hypertension cases, specialists with particular interest and experience are needed for complex cases.