EMERGING STRATEGIES FOR THE MANAGEMENT OF CV RISK FACTORS IN HYPERTENSION

Last weekend, I flew out to Hanoi on Friday to speak on the above topic at a Sanofi Aventis organised workshop for GPs in the ASEAN region. The "Hot Topics" were on Hypertension, Atrial Fibrillation and Diabetes. It was a Saturday, Sunday seminar, but I returned on Saturday evening.
I wish to always acknowledge Sanofi Aventis, who have been supporting CME ( continual medical education ) strongly, be it Nationally, Regionally or internationally. Of course, it is also promoting their product, in this case, I am sure that it has to do with Irbesartan for hypertension. Nonetheless, they have ben very supportive and their effort should be acknowledged. I always wonder what will happen when pharmas stop supporting CMEs and doctors have to pay to attend CMEs. I am sure they will, i) Not attend unless mandated by law, ii) pass the cost on to the patient, iii) try and armtwist the pharmas who are supplying them the drugs, to sponsor.

Anyway, my brief was " Emerging Strategies in the Management of CV risk factors in Hypertension. I have never learn how to post my teaching slides in the blog, so I will just give a gist of what I said.
1. I stress that as a country and a community, it is best to prevent hypertension. If we can prevent hypertension (currently standing at about 40% in Malaysia), we would automatically reduce CV risk. There is much work done in preventing hypertension. The better know strategies are losing weight,( cut down obesity), taking a no added salt diet, indulge in a regular exercise program ( even moderate exercise will help ), and the lesser known strategies namely sleep well ( 6-8 hours of good sleep is very important to maintain good CV health ), and also the taking of drugs ( some drugs have been shown to prevent hypertension when taken for a short duration of 2 years ). We do not prefer the last appraoch as it obvious cost money and also exposes the patient to side effects. We would very much encourage the initial 4 startegies, of losing weight, eat less salt, exercise regularly and also sleep well.
2. Of course, should you have hypertension already, it is important to have a cardiac assesment done to make sure that you do not have LVH ( left Ventricular Hypertrophy ) as LVH is an important CV risk factors associated with a higher risk of heart attacks and strokes. Certain drugs like Irbesartan have been know to regress LVH and improve the CV outcomes. The other important issue is to see if there are proteins ( even just traces ) in the urine. Micro-albuminuria is another important CV risk factor for heart attacks and strokes in ptients with hypertension. And of course, there is enough clinical evidence to say that ARBs like Irbesartan can reduce micro-albuminuria, and improve the CV outcomes.
3. I also encourage the audience to control hypertension well, and to treat the whole patient for all the other CV risk factors of the aptient, like diabetes, cigarette smoking and also to lower their cholesterol.
All in all, it was a good meeting. The question time was full of questions and also the informal interaction was good.

Unfortunately, I had other appointments in KL that I had to attend to, so that I did not get to see much of Hanoi, except the airport, the roads to and fro and also the Hanoi Hilton. I would have to visit Hanoi again. I am told that it is a nice place.