Generic placeholder image

Current Pharmaceutical Design


ISSN (Print): 1381-6128
ISSN (Online): 1873-4286

General Review Article

Improvement in Hypertension Management with Pharmacological and Non- Pharmacological Approaches: Current Perspectives

Author(s): Dongsheng Hong* and Wenya Shan

Volume 27, Issue 4, 2021

Published on: 22 September, 2020

Page: [548 - 555] Pages: 8

DOI: 10.2174/1381612826666200922153045

open access plus


Purpose: Improving hypertension management is still one of the biggest challenges in public health worldwide. Existing guidelines do not reach a consensus on the optimal Blood Pressure (BP) target. Therefore, how to effectively manage hypertension based on individual characteristics of patients, combined with the pharmacological and non-pharmacological approach, has become a problem to be urgently considered.

Methods: Reports published in PubMed that covered Pharmacological and Non-Pharmacological Approaches in subjects taking hypertension management were reviewed by the group independently and collectively. Practical recommendations for hypertension management were established by the panel.

Results: Pharmacological mechanism, action characteristics, and main adverse reactions varied across different pharmacological agents, and patients with hypertension often require a combination of antihypertensive medications to achieve the target BP range. Non-pharmacological treatment provides an additional effective method for improving therapy adherence and long-term BP control, thus reducing the risk of cardiovascular diseases, and slowing down the progression of the disease.

Conclusion: This review summarizes the available literature on the most convincing guideline principles, pharmacological treatment, biotechnology interference, interventional surgical treatment, managing hypertension with technical means of big data, Artificial Intelligence and Behavioral Intervention, as well as providing future directions, for facilitating Current and Developing knowledge into clinical implementation.

Keywords: Antihypertensive drugs, hypertension management, biotechnology interference, artificial intelligence, pharmacological approaches, cardiovascular diseases.

Cooper RS, Kaufman JS, Bovet P. Global Burden of Disease Attributable to Hypertension. JAMA 2017; 317(19): 2017-8.
[] [PMID: 28510671]
Egan BM, Kjeldsen SE, Grassi G, Esler M, Mancia G. The global burden of hypertension exceeds 1.4 billion people: should a systolic blood pressure target below 130 become the universal standard? J Hypertens 2019; 37(6): 1148-53.
[] [PMID: 30624370]
Mills KT, Bundy JD, Kelly TN, et al. Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies From 90 Countries. Circulation 2016; 134(6): 441-50.
[] [PMID: 27502908]
van Kleef ME, Spiering W. Hypertension: Overly important but under-controlled. Eur J Prev Cardiol 2017; 24(3 Suppl.): 36-43.
[] [PMID: 28618912]
Collaborators GBDRF. GBD 2015 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388(10053): 1659-724.
[] [PMID: 27733284]
Dzau V, Balatbat C. Future of Hypertension: The Need for Transformation. Hypertension 2019; 74.
Daugherty SL, Powers JD, Magid DJ, et al. Incidence and prognosis of resistant hypertension in hypertensive patients. Circulation 2012; 125(13): 1635-42.
[] [PMID: 22379110]
Currie G, Delles C. The Future of “Omics” in Hypertension. Can J Cardiol 2017; 33(5): 601-10.
[] [PMID: 28161100]
Savoia C, Volpe M, Grassi G, Borghi C, Agabiti Rosei E, Touyz RM. Personalized medicine-a modern approach for the diagnosis and management of hypertension. Clin Sci (Lond) 2017; 131(22): 2671-85.
[] [PMID: 29109301]
Peeters LEJ, Kester MP, Feyz L, et al. Pharmacokinetic and pharmacodynamic considerations in the treatment of the elderly patient with hypertension. Expert Opin Drug Metab Toxicol 2019; 15(4): 287-97.
[] [PMID: 30880496]
Krittanawong C, Bomback AS, Baber U, Bangalore S, Messerli FH, Wilson Tang WH. Future Direction for Using Artificial Intelligence to Predict and Manage Hypertension. Curr Hypertens Rep 2018; 20(9): 75.
[] [PMID: 29980865]
Persell SD, Karmali KN, Stein N, et al. Design of a randomized controlled trial comparing a mobile phone-based hypertension health coaching application to home blood pressure monitoring alone: The Smart Hypertension Control Study. Contemp Clin Trials 2018; 73: 92-7.
[] [PMID: 30172038]
Egan BM. Prediction of incident hypertension. Health implications of data mining in the ‘Big Data’ era. J Hypertens 2013; 31(11): 2123-4.
[] [PMID: 24096252]
Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 140(11): e596-646.
[] [PMID: 30879355]
Williams B, Mancia G, Spiering W, et al. ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39(33): 3021-104.
[] [PMID: 30165516]
Joint Committee for Guideline Revision. 2018 Chinese Guidelines for Prevention and Treatment of Hypertension-A report of the Revision Committee of Chinese Guidelines for Prevention and Treatment of Hypertension. J Geriatr Cardiol 2019; 16(3): 182-241.
[PMID: 31080465]
Kario K, Iwashita M, Okuda Y, et al. Morning Home Blood Pressure and Cardiovascular Events in Japanese Hypertensive Patients. Hypertension 2018; 72(4): 854-61.
[] [PMID: 30354719]
Gauer R. Severe Asymptomatic Hypertension: Evaluation and Treatment. Am Fam Physician 2017; 95(8): 492-500.
[PMID: 28409616]
Kaplan NM. Joint National Committee. New JNC-6 guidelines. Am J Kidney Dis 1998; 31(5): 864-5.
[PMID: 9590201]
Guidelines Subcommittee. 1999 World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension. J Hypertens 1999; 17(2): 151-83.
[PMID: 10067786]
Guidelines Committee. 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 2003; 21: 1011-53.
Wang G, Grosse SD, Schooley MW. Conducting Research on the Economics of Hypertension to Improve Cardiovascular Health. Am J Prev Med 2017; 53(6)(Suppl. 2): S115-7.
[] [PMID: 29153111]
Kolb TM, Hassoun PM. Supply and Demand: Micro(vascular) Economics of the Right Ventricle in Pulmonary Hypertension. Am J Respir Cell Mol Biol 2018; 59(4): 410-1.
[] [PMID: 29995431]
Haller MC, Vanholder R, Oberbauer R, Zoccali C, Van Biesen W. Health economics and European Renal Best Practice--is it time to bring health economics into evidence-based guideline production in Europe? Nephrol Dial Transplant 2014; 29(11): 1994-7.
[] [PMID: 24009293]
Mendizábal B, Urbina EM, Becker R, et al. SHIP-AHOY (Study of High Blood Pressure in Pediatrics: Adult Hypertension Onset in Youth). Hypertension 2018; 72(3): 625-31.
[] [PMID: 29987102]
Irigoyen MC, De Angelis K, Dos Santos F, Dartora DR, Rodrigues B, Consolim-Colombo FM. Hypertension, Blood Pressure Variability, and Target Organ Lesion. Curr Hypertens Rep 2016; 18(4): 31.
[] [PMID: 27002717]
Harbaoui B, Courand PY, Defforges A, et al. Cumulative Effects of Several Target Organ Damages in Risk Assessment in Hypertension. Am J Hypertens 2016; 29(2): 234-44.
[] [PMID: 26112867]
Braam B, Taler SJ, Rahman M, et al. Recognition and Management of Resistant Hypertension. Clin J Am Soc Nephrol 2017; 12(3): 524-35.
[] [PMID: 27895136]
Leung AA, Daskalopoulou SS, Dasgupta K, et al. Hypertension Canada. Hypertension Canada’s 2017 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults. Can J Cardiol 2017; 33(5): 557-76.
[] [PMID: 28449828]
Ghazi L, Oparil S. Impact of the SPRINT Trial on Hypertension Management. Annu Rev Med 2018; 69: 81-95.
[] [PMID: 29414255]
Wang W, Ma LY, Liu MB, et al. CHIEF Cooperative Group. Effects of amlodipine plus telmisartan or amlodipine plus amiloride regimen on blood pressure control in hypertensive patients: preliminary report of Chinese Hypertension Intervention Efficacy (CHIEF) trial. Zhonghua Xin Xue Guan Bing Za Zhi 2009; 37(8): 701-7.
[PMID: 20021921]
Huo Y, Li J, Qin X, et al. CSPPT Investigators. Efficacy of folic acid therapy in primary prevention of stroke among adults with hypertension in China: the CSPPT randomized clinical trial. JAMA 2015; 313(13): 1325-35.
[] [PMID: 25771069]
Han X, Zhang Y, Dong L, et al. Treatment of Pulmonary Arterial Hypertension Using Initial Combination Therapy of Bosentan and Iloprost. Respir Care 2017; 62(4): 489-96.
[] [PMID: 28119496]
Borghi C, Cicero AF. Nutraceuticals with a clinically detectable blood pressure-lowering effect: a review of available randomized clinical trials and their meta-analyses. Br J Clin Pharmacol 2017; 83(1): 163-71.
[] [PMID: 26852373]
Holzgreve H. Combination versus Monotherapy as Initial Treatment in Hypertension. Herz 2003; 28(8): 725-32.
[] [PMID: 14689107]
Kim KI, Shin MS, Ihm SH, et al. A Randomized, Double-blind, Multicenter, Phase III Study to Evaluate the Efficacy and Safety of Fimasartan/Amlodipine Combined Therapy Versus Fimasartan Monotherapy in Patients With Essential Hypertension Unresponsive to Fimasartan Monotherapy. Clin Ther 2016; 38(10): 2159-70.
[] [PMID: 27502326]
Ernst E. Integrated medicine. J Intern Med 2012; 271(1): 25-8.
[] [PMID: 21682782]
Kawada T. Thiazide diuretics and fracture in patients with hypertension. J Hypertens 2017; 35(3): 645-6.
[] [PMID: 28121841]
Bokrantz T, Ljungman C, Kahan T, et al. Thiazide diuretics and the risk of osteoporotic fractures in hypertensive patients. Results from the Swedish Primary Care Cardiovascular Database. J Hypertens 2017; 35(1): 188-97.
[] [PMID: 27749388]
Khan YH, Sarriff A, Adnan AS, Khan AH, Mallhi TH. Diuretics prescribing in chronic kidney disease patients: physician assessment versus bioimpedence spectroscopy. Clin Exp Nephrol 2017; 21(3): 488-96.
[] [PMID: 27402286]
Mann SJ. Redefining beta-blocker use in hypertension: selecting the right beta-blocker and the right patient. J Am Soc Hypertens 2017; 11(1): 54-65.
[] [PMID: 28057444]
Meyer M, LeWinter MM. Heart Rate and Heart Failure With Preserved Ejection Fraction: Time to Slow β-Blocker Use? Circ Heart Fail 2019; 12(8): e006213.
[] [PMID: 31525068]
Faxon DP. Beta-blocker therapy and primary angioplasty: what is the controversy? J Am Coll Cardiol 2004; 43(10): 1788-90.
[] [PMID: 15145100]
Lindholm LH, Carlberg B, Samuelsson O. Should beta blockers remain first choice in the treatment of primary hypertension? A meta-analysis. Lancet 2005; 366(9496): 1545-53.
[] [PMID: 16257341]
Tran KC, Leung AA, Tang KL, Quan H, Khan NA. Efficacy of Calcium Channel Blockers on Major Cardiovascular Outcomes for the Treatment of Hypertension in Asian Populations: A Meta-analysis. Can J Cardiol 2017; 33(5): 635-43.
[] [PMID: 28377067]
Sica DA. Calcium channel blocker class heterogeneity: select aspects of pharmacokinetics and pharmacodynamics. J Clin Hypertens (Greenwich) 2005; 7(4)(Suppl. 1): 21-6.
[] [PMID: 15858399]
Turner JM, Kodali R. Should Angiotensin-Converting Enzyme Inhibitors ever Be Used for the Management of Hypertension? Curr Cardiol Rep 2020; 22(9): 95.
[] [PMID: 32648000]
Liang DL, Li XY, Wang L, Xu H, Tuo XP, Jian ZJ. Current status and influence factors of ACEI/ARB application in elderly coronary heart disease outpatients complicated with diabetes mellitus in China. Zhonghua Yi Xue Za Zhi 2016; 96(36): 2917-22.
[PMID: 27760640]
Hao G, Wang Z, Guo R, et al. Effects of ACEI/ARB in hypertensive patients with type 2 diabetes mellitus: a meta-analysis of randomized controlled studies. BMC Cardiovasc Disord 2014; 14: 148.
[] [PMID: 25344747]
Rajagopalan S, Kariisa M, Dellegrottaglie S, et al. Angiotensin receptor blockade improves vascular compliance in healthy normotensive elderly individuals: results from a randomized double-blind placebo-controlled trial. J Clin Hypertens (Greenwich) 2006; 8(11): 783-90.
[] [PMID: 17086018]
Chen PG, Sun Z. AAV Delivery of Endothelin-1 shRNA Attenuates Cold-Induced Hypertension. Hum Gene Ther 2017; 28(2): 190-9.
[] [PMID: 27736201]
Yuan LF, Sheng J, Lu P, Wang YQ, Jin T, Du Q. Nanoparticle-mediated RNA interference of angiotensinogen decreases blood pressure and improves myocardial remodeling in spontaneously hypertensive rats. Mol Med Rep 2015; 12(3): 4657-63.
[] [PMID: 26062941]
Patel RS, Scopelliti EM, Olugbile O. The Role of PCSK9 Inhibitors in the Treatment of Hypercholesterolemia. Ann Pharmacother 2018; 52(10): 1000-18.
[] [PMID: 29667842]
Fitzgerald K, Frank-Kamenetsky M, Shulga-Morskaya S, et al. Effect of an RNA interference drug on the synthesis of proprotein convertase subtilisin/kexin type 9 (PCSK9) and the concentration of serum LDL cholesterol in healthy volunteers: a randomised, single-blind, placebo-controlled, phase 1 trial. Lancet 2014; 383(9911): 60-8.
[] [PMID: 24094767]
Eirin A, Lerman LO. Stem cell-derived extracellular vesicles for renal repair: do cardiovascular comorbidities matter? Am J Physiol Renal Physiol 2019; 317(6): F1414-9.
[] [PMID: 31630544]
de Oliveira LF, Almeida TR, Ribeiro Machado MP, et al. Priming Mesenchymal Stem Cells with Endothelial Growth Medium Boosts Stem Cell Therapy for Systemic Arterial Hypertension. Stem Cells Int 2015; 2015: 685383.
[] [PMID: 26300922]
Mohamed TMA, Ang YS, Radzinsky E, et al. Regulation of Cell Cycle to Stimulate Adult Cardiomyocyte Proliferation and Cardiac Regeneration Cell 2018; 173: 104-16.
Pereira EA, Wang S, Paterson DJ, Stein JF, Aziz TZ, Green AL. Sustained reduction of hypertension by deep brain stimulation. J Clin Neurosci 2010; 17(1): 124-7.
[] [PMID: 19664927]
Mousa AY, AbuRahma AF, Bozzay J, Broce M, Bates M. Update on intervention versus medical therapy for atherosclerotic renal artery stenosis. J Vasc Surg 2015; 61(6): 1613-23.
[] [PMID: 26004332]
Tucker KL, Sheppard JP, Stevens R, et al. Self-monitoring of blood pressure in hypertension: A systematic review and individual patient data meta-analysis. PLoS Med 2017; 14(9): e1002389.
[] [PMID: 28926573]
Omboni S, Caserini M, Coronetti C. Telemedicine and M-Health in Hypertension Management: Technologies, Applications and Clinical Evidence. High Blood Press Cardiovasc Prev 2016; 23(3): 187-96.
[] [PMID: 27072129]
Piette JD, List J, Rana GK, Townsend W, Striplin D, Heisler M. Mobile Health Devices as Tools for Worldwide Cardiovascular Risk Reduction and Disease Management. Circulation 2015; 132(21): 2012-27.
[] [PMID: 26596977]
Gomberg-Maitland M, Souza R. Uncovering Small Secrets in Big Data Sets: How Math Can Identify Biology in Rare Conditions (Pediatric Pulmonary Hypertension). Circ Res 2017; 121(4): 317-9.
[] [PMID: 28775006]
Kotchen TA, Cowley AW Jr, Liang M. Ushering Hypertension Into a New Era of Precision Medicine. JAMA 2016; 315(4): 343-4.
[] [PMID: 26769233]
The Lancet. China’s health-care reform: an independent evaluation. Lancet 2019; 394(10204): 1113.
[] [PMID: 31571585]
Du X, Patel A, Anderson CS, Dong J, Ma C. Epidemiology of Cardiovascular Disease in China and Opportunities for Improvement: JACC International. J Am Coll Cardiol 2019; 73(24): 3135-47.
[] [PMID: 31221263]
Johnson RA, Huntley A, Hughes RA, et al. Interventions to support shared decision making for hypertension: A systematic review of controlled studies. Health Expect 2018; 21(6): 1191-207.
[] [PMID: 30221454]
Zhang XN, Qiu C, Zheng YZ, Zang XY, Zhao Y. Self-management among elderly patients with hypertension and its association with individual and social environmental factors in China. J Cardiovasc Nurs 2019; 35(1): 45-53.
[PMID: 31373957]
Münzel T, Sørensen M, Gori T, et al. Environmental stressors and cardio-metabolic disease: part II-mechanistic insights. Eur Heart J 2017; 38(8): 557-64.
[PMID: 27460891]
Carey RM, Muntner P, Bosworth HB, Whelton PK. Prevention and Control of Hypertension: JACC Health Promotion Series. J Am Coll Cardiol 2018; 72(11): 1278-93.
[] [PMID: 30190007]
Lackland DT, Weber MA. Global burden of cardiovascular disease and stroke: hypertension at the core. Can J Cardiol 2015; 31(5): 569-71.
[] [PMID: 25795106]
Wu D, Tang X, Ding L, et al. Candesartan attenuates hypertension-associated pathophysiological alterations in the gut Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie 2019.
Viera AJ, Hawes EM. Management of mild hypertension in adults. BMJ 2016; 355: i5719.
[] [PMID: 27872051]
Collaborators GBDRF. GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392(10159): 1923-94.
[] [PMID: 30496105]

© 2023 Bentham Science Publishers | Privacy Policy