Scientists May Develop a Single Pill to Treat High Blood Pressure
By Gay Jervey
Scientists in Great Britain have recently announced that they are on the threshold of developing the first effective single pill to combat high blood pressure. The team’s research, presented in the March 2017 journal Hypertension, found that the nitric oxide that regulates blood pressure is formed in nerves rather than in the walls of blood vessels, the prevailing theory. The information is helping doctors develop a pill that mimics the body’s response and triggers the release of nitric oxide, helping lower blood pressure significantly. The findings also suggest a stronger link than previously thought between the brain, which controls the nerves, blood pressure and human emotions.
The study was led by Professor Ajay Shah, British Heart Foundation Chair of Cardiology at King’s College Hospital, in London. The team treated healthy human subjects with a drug that inhibited an enzyme in the nerves from producing nitric oxide. To their surprise, reducing production of this gas led to a significant decrease in blood pressure itself. If a pill is developed and successful, it will be welcome news to the millions of sufferers who often need to take a combination of medications to tackle the multiple factors contributing to hypertension.
This innovation is promising. However, it is not likely to change the confusion that surrounds the diagnosis; while one in three Americans suffers from high blood pressure, many are still baffled by and struggle with this diagnosis.
You’ve heard the stories, and they often go something like this: “I hadn’t been to the doctor in awhile, and didn’t realize I had high blood pressure. When I finally got it checked, my reading was quite elevated. I exercise regularly, feel absolutely fine and never eat salt, so how could I possibly have high blood pressure? Why me?”
The sense of surprise is understandable. Dr. William C. Hunter—a Philadelphia area internist who trained at The University of Pennsylvania and Johns Hopkins Hospital—explains that, unlike many other illnesses, hypertension generally sparks few, if any symptoms. In some instances, people can develop headaches when their blood pressure rises to dangerous levels, but all too often, our bodies don’t alert us to untreated hypertension until it is too late and someone experiences a heart attack or stroke.
For a Silent, Stealthy Killer, a Multi-Pronged Treatment Strategy
“This is precisely why hypertension is so ominous—it is a silent killer,” Dr. Hunter offers. “Real, live, tangible symptoms make any diagnosis more real and easier to accept, which is why this particular condition can sometimes be so tough for people to process. They don’t want to see themselves as being sick. That’s the biggest hurdle. You look good, you feel good, and you’re living your life. But the bottom line is that you have a serious chronic condition, which you will need to take care of on an ongoing basis.”
Another confounding aspect of hypertension is that there is rarely just one contributing origin; numerous forces are almost always at work. Some causes, such as genetics and age, can’t be prevented, Dr. Hunter emphasizes. On the other hand, tackling modifiable risk factors, for example, poor diet and lack of exercise, often produces satisfactory results.
“Whenever possible, before prescribing drugs, we try to help our patients manage their hypertension through lifestyle and nutrition changes,” he notes. “Get more exercise, get rid of the sodium. When necessary, lose the weight. Contrary to popular opinion, physicians really don’t like to push pills. As with diabetes and some other chronic conditions, most of the time we try to educate the patient and help them change their behavior before we start with prescriptions.” But, if medications are necessary, Dr. Hunter explains, “the good news is that we can very effectively control your hypertension.”
Dr. Hunter adds, “Many things go into managing your blood pressure.” “It depends on the blood vessels—how tight and how relaxed they are. How forcefully your heart has to work. The kidneys play a role, the lungs play a role. So, most people will require several agents to attack the different mechanisms at play. Each one of these regimens has to be individually tailored to the person. And sometimes there is a little bit of trial and error before we hit the precise combination of drugs necessary.”
Risk Increases Naturally As We Get Older
Unfortunately, the reality is that the lifelong chances of ultimately developing some level of hypertension are fairly high, and dramatically increase as we age. “The performance of our cardiovascular systems decreases as we get older. It’s just the natural progression of life and our organ systems,” Dr. Hunter says.
There are several reasons for this decline:
• An aging heart, which is inevitable, even if you have a healthy diet and exercise frequently.
• Blood vessels show a diminished performance.
• Older people tend to live more sedentary lives, a known factor for high blood pressure. One invaluable way to stop the clock and minimize your risk as you age is to keep as active as possible.
Dr. Hunter recommends that those with hypertension invest in a home measurement device and consult with their physician on the best type to buy, and how to optimally use it.
And above all else: Don’t despair. “With the right attitude, when you work with your primary care provider, there is no reason to panic,” Dr. Hunter counsels. “Worrying and stressing will only make it worse. You can get your blood pressure under control so you can live a long and healthy life.”
Despite its importance, nitric oxide only came to prominence around 25 years ago when a group of American pharmacologists discovered its properties as a ‘signalling system’ in the cardiovascular system. Their discovery earned them the Nobel Prize for Medicine in 1998. Further research has proved the crucial role the gas plays in such fundamental biological processes such as the functioning of the immune system, and different functions of the nervous system. Importantly, nitric oxide works as a vasodilator, relaxing narrowed blood vessels, and thus increasing blood flow and oxygen delivery to vital organs. One of the most prominent pharmaceutical applications of its discovery was the creation of Viagra.
Blood pressure is measured with two numbers, systolic and diastolic. The systolic number represents the measure of pressure when the heart is contracting, the diastolic is when the heart is expanding. In general, according to the American Heart Association, around 120/80 (120 systolic and 80 diastolic) is considered normal.
American Heart Association, heart.org