Vaccination against Hypertension?

At the just concluded American Heart Association annual scientific meeting in Orlando, Florida, the Swiss team presented their phase 2a study of a vaccine for hypertension. Phase 2 study is essentially one of dosing and safety. They studied 72 patients given an antigen against Angiotensin II, given at day zero, two months and three months. The patients were followed for four months. They tried two dosages and they were compared with a placebo.

The researchers found that the vaccines were safe and the adverse effects were minor. The regime also had a positive effect with good control of blood pressure, especially with the higher antigen dose. Obviously, more study needs to be done, to further test safety and also to get the dosages right.

The idea of a vaccine for a chronic condition like hypertension makes sense. It allows for much better patient compliance. You do not have to take pills everyday and also you may only need to visit your doctors maybe three to four times a year. Obviously, safety is a great concern. Angiotensin II, as part of the Renin-Angiotensin-Aldosterone system, has a purpose and antibodies against angiotensin II, cannot come without a cost. Pregnancies, patients with cardiac and renal conditions, just to mention a few. Well, obviously time will tell, as more studies are done. Certainly the idea is good.

What if I have hypertension at 80?

What would you do if you have hypertension, when you are 75 or 80 yrs old? Would you want to take pills daily for the rest of your life or would you just leave it alone, as you are old enough? What is life at 80? To live longer or to live better?

For a long time, we did not know if treating hypertension at 80 made any difference. Studies that included this age group, in many clinical trials, were in small numbers and in many ways, not definitive. Well, that was until Dr Chris Bulpitt of Imperial College (UK), announced this week the premature closure of the "Hypertension in the Very Elderly Trial". This trial was due to be completed by 2009. But the Drug safety and monitoring committee advised the early stopped to the study because there was an obvious benefit in treatment. They decided to open the label, and allow the patients in the placebo group to take the treatment.

This study included 3845 patients who were all over 80 yrs. They all had hypertension, and they come from across the world including Eastern and Western Europe, Tunisia and China. The treatment arm received the usual dose of indapamide and coversyl. There was a significant reduction in strokes and cardiac mortality in the treatment arm. Basically, lowering blood pressure to target, will reduce the rates of strokes and also cardiac deaths. At 80, stroke is a real devastator and makes life so different. Reduction in cardiac mortality, in this age group, is a moot point. Living well may be, in my opinion, much much more important.

Indapamide and coversyl, are both fairly cheap and well tolerated drugs. The dose of coversyl were only 2-4 mgs instead of the big 8mgs dose of coversyl that is now being pushed around. The side effects were low. Even in my own practice, treatment was very individualised. Sometimes I treat, and usually with an ACE-I or Natrilix SR (Indapamide), and sometimes, I just leave them on moderate lifestyle changes. Natrilix SR has, in my practice, been a very useful drug, effective and safe. I suppose, the message here would be that, it is still very worthwhile to treat octogenarians with significant hypertension.