Managing Hypertension

How can the Media-stats portal and BP+ be useful for prescribing hypertension medications?

Measuring arterial stiffness with BP+ can help:

  • Decide which borderline hypertensive patients may benefit from medication: patients that present with blood pressures such as 137/89 may benefit from treatment. An elevated arterial stiffness is evidence that treatment may be warranted.

  • Choose an appropriate class of hypertension medication: Choosing whether to prescribe an ACE inhibitor, ARB, CCB, Beta blocker or diuretic can be difficult. You need to consider many factors. However, if a patient has high arterial stiffness, ACE inhibitors and ARBs may be more appropriate as they help to relax blood vessels. Beta-Blockers may be contra indicated as they may increase arterial stiffness.

  • Determine the dose of medication to prescribe: Medicines have side-effects. BP+ makes the dose-response relationship visible and allows the most cost-effective dose to be chosen.

How can BP+ help stratify pre-hypertensive patients?

If a patient has moderately high blood pressure, you may wish to consider their augmentation index to help determine whether he or she needs treatment. For example, moderately high blood pressure with moderate arterial stiffness may indicate nothing of particular concern. However, moderately high blood pressure with high arterial stiffness may indicate your patient is at increased risk of cardiovascular events later in life. The following device screen shots show a range of arterial stiffness values for acceptable to moderate blood pressures.

bpplus-ai-index-graph.jpg

What blood pressure medications affect arterial stiffness?

Certain kinds of blood pressure medications affect arterial stiffness directly (they are vasoactive), which in turn reduces blood pressure. Other classes of medication have little direct effect on arterial stiffness.

Vasoactive blood pressure medications include:

  • Angiotensin-converting enzyme inhibitors (ACE inhibitors)

  • Angiotensin II receptor antagonists, also called angiotensin II receptor blockers (ARBs)

Non-vasoactive blood pressure medications include:

  • Beta-blockers

  • Diuretics

How does BP+ measure the effect of vasoactive medications?

An example of the effect of an ARB on augmentation index (AI) is given below. You can see AI increases substantially when the patient stops taking his medication (AI increases prior to significant changes in BP). AI returns to normal once medication is resumed.

bpplus-effect-of-arb.jpg

How do I know what is a good level of medication?

The appropriate dose of medication is dependent on a number of factors. One consideration may be to improve arterial stiffness towards a level that is normal as measured in people who are generally healthy.