Hypertension or high blood pressure is a condition that affects many adults in Kenya. Indeed, the ailment is a major contributor to the high non-communicable (NCD) disease burden in the country.
A 2020 study conducted in Kenya and published in the BMC Public Health Journal, indicated that close to a quarter of adults in Kenya (about 21 percent) suffer from the condition. These are people with a blood pressure reading of 140/90 mmHg or higher. The normal measurement for healthy people is 120/80 mmHg.
In addition, the research found that about one in every two adults in the country has prehypertension. These are individuals whose blood pleasure is slightly above what is considered normal (140/90 mmHg or higher) but is not high enough to warrant a hypertension diagnosis. This ‘middle-ground’ group is at great risk of suffering from the disease if interventions aimed at lowering the pressure are not put in place.
In its initial stages, high blood pressure or hypertension may appear harmless as people having it may not exhibit any noticeable symptoms. But as the pressure intensifies, it predisposes those affected to life threatening ailments such as strokes, heart attacks, kidney failure, vision loss and memory problems.
To avert these challenges, prompt diagnosis and treatment with approved drugs are recommended. This approach usually works well for most people. But there are some individuals who may continue to have high blood pressure levels irrespective of taking the drugs administered to them in recommended doses.
In such situations, doctors usually have to weigh many factors, to determine the way forward so as to offer care to patients in a manner that will solve the problem without jeopardising their health.
A new study published in the Internal Medicine Journal offers insights into this matter. The researchers note that its findings may help affected patients and their doctors to decide whether to increase the dose of one of their existing drugs, or add a new one, with the aim of bringing down their blood pressure and lowering their risk of future health problems.
Based on the results of the study, patients have a better chance of sticking to their medication regimen if their doctor maximises the dosage of one of the drugs they are already taking.
“Both strategies decrease blood pressure. But adding a new medication has a very slim advantage over increasing the dose of an existing medication, despite some of the patients being unable to stay on the new medication,” noted the researchers from the US based University of Michigan and the VA Ann Arbor Healthcare System that conducted the study.
Dr Carole Aubert, the lead author of the study stated that the study is the first to directly compare the effects of the two strategies – increasing doses of existing medication or introducing new ones altogether – so as to intensify the treatment for patients struggling to lower their blood pressure.
The researchers further note that findings of the study could add to discussions between physicians and patients whose blood pressure remains elevated despite starting medication treatment.
Deciding on the best approach to take is important because the intensification of blood pressure treatment can come with risks for the patients. These include adverse reactions to new stronger drugs, electrolyte imbalance of body fluids caused by higher drug doses or fainting and falling if a person’s blood pressure gets too low
During the study, the researchers analysed data of nearly 179,000 individuals, aged 65 and above, who had been receiving hypertension treatment for over two years. The analysis enabled them to see patterns in treatment and blood pressure readings over time, among patients that received more intense treatment.
“There’s increasing guidance on approaches to starting treatment in older adults, but less on the next steps to intensify treatment, especially in an older and medically complex population that isn’t usually included in clinical trials of blood pressure medication,” said Dr Aubert.
“So, the challenge we have been grappling with, is how to increase medications safely in a population already taking many medications for hypertension and other conditions.”
Dr Lilian Min, a senior author of the study noted that treatment guidelines suggest starting treatment with multiple medications, and that clinicians are usually comfortable with an approach of ‘starting low and going slow’ in older patients.
But based on the findings of the study, she stated that clinicians now have a further opportunity to tailor choices in intensifying drug therapy for hypertension, depending on the individual patient’s characteristics when dealing with older populations.
“Is the patient more likely to stick to a simpler regimen? Then increase an existing medication. Or is the blood pressure very high and the clinician is more concerned about reducing it? Then consider starting a new medication now,” said Dr Min, who is also a geriatrician at the Division of Geriatrics and Palliative Care at the University of Michigan’s academic medical centre, as well as the VA Ann Arbor Healthcare System Geriatric Research Education and Clinical Centre
For older adults who already take a range of medications, the research indicates that the added complexity of having to take one more kind of pill may be too much, hence requiring clinicians to carefully think through the best approach for managing them.