Society – hypertension: the drug does not work for everyone

Published in 11/2022 – Released June 14, 2022

Bolzano / Val Venosta – Many older people ingest one or more blood pressure tablets with their morning coffee. But pills don’t always work. Data from the CHRIS study, the population study of Eurac Research and the South Tyrolean medical company, now form a valuable basis for investigating why hypertension therapies do not work in some people. For example, the research team working on the HyperProfile study is using biomarkers to measure the effectiveness of certain drugs on one of the biological processes that control high blood pressure. Biologist Luisa Foco from the Eurac Research Institute of Biomedicine is the lead researcher.

the Val Venosta: Does it often happen that high blood pressure therapies don’t work?

Luisa Focus: Of the people who participated in the first phase of the CHRIS study, 1,814 were already being treated for high blood pressure. However, in about half of the cases, the blood pressure was not under control. In some cases drug therapy can be regulated even better, in other cases we can speak of true resistance. Hypertension is often due to a lack of discipline in taking medications and a bad lifestyle, but there is also a not inconsiderable percentage of people for whom high blood pressure medications do not work.

What are the most commonly used drugs?

One of the most common combinations currently used for hypertension is a combination of three: an ACE inhibitor or sartans, a diuretic, and a calcium channel blocker. About 30% of CHRIS participants with high blood pressure take ACE inhibitors or sartan, and another 18.5% also take a diuretic. 154 people were prescribed the currently most commonly used combination. We are talking about people who take at least three pills a day and, despite everything, 87 of them, more than 56 percent, still have high blood pressure.

Why is this?

To understand why drugs cannot regulate blood pressure, the first step is to examine what happens at the molecular level in people who do not respond to therapy. How blood pressure is controlled is like watching a movie in which countless actors take part, with the so-called “renin-angiotensin-aldosterone system” (RAAS for short) playing the lead role. The main antihypertensive drugs work precisely on this system.

How does the data from the CHRIS study contribute to this research?

For each CHRIS participant profile, we review six biomarkers that indicate how this RAAS process works. It has been confirmed that the drugs work, but also that they are not always effective. For example, there are people who have much higher adrenal activity than would be expected because they take drugs that inhibit the production of a hormone called aldosterone. This could indicate that the high blood pressure is the result of another disease, namely primary aldosteronism. In this case, blood pressure could be controlled simply by changing medications. In general, the markers we study can help doctors choose the best therapy.

I study

Research partners include the Eurac Research Institute for Biomedicine, the University of Glasgow, the French research institute Inserm and Schlanders Hospital. In particular, Dr. Stefano Barolo, head of the clinic for arterial hypertension and cardiovascular risks, the study and warns: “In Italy one in three people suffer from what is called hypertension. This number will increase in the future due to the aging of the population. Why? with age, the elasticity of the artery walls decreases, which leads to an increase in systolic blood pressure Angiotensin-aldosterone system.

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