Clinical Updates On Blood Pressure Management – An Alternative Approach To Treat First Grade Hypertension
Despite being often asymptomatic, Hypertension has been identified as the leading preventable cause of death and disability-adjusted life years worldwide since the year 1990, with up to 45% of the adult population being affected by the disease.
The definition and categories of hypertension have been evolving over the years with cut-off been progressively decreased together with the recognition of relevant positive association between relatively high blood pressure and rate of major cardiovascular events and all-cause deaths.
Therefore, in 2017, the American College of Cardiology/American Heart Association (ACC/AHA) clinical practice guidelines for high BP recategorized BP classification to exclude prehypertension and emphasizing the progressively higher risk of cardiovascular disease going from normal BP (<120/80 mm Hg), to elevated BP (120–129/<80 mm Hg) and stage 1 hypertension (systolic BP 130–139 mm Hg or diastolic 80–89 mm Hg).
According to the WHO (WHO, 2023) an estimated 1.28 billion adults aged 30 to 79 are living with hypertension, 46% are unaware of their condition, only 42% receive treatment, and just 1 in 5 have their blood pressure adequately controlled.
Pathophysiology in a nutshell:
There are various mechanisms underpinning the development of hypertension, which include increased salt absorption resulting in volume expansion, an impaired response of the renin-angiotensin-aldosterone system (RAAS), and increased activation of the sympathetic nervous system. These changes lead to the development of increased total peripheral resistance and increased afterload, which in turn leads to the development of hypertension.
How to increase early detection:
As the Improving the Detection of Hypertension trial suggested, 1 week of HBP monitoring (measured twice in the morning and twice in the evening) may be the most reliable method for diagnosing hypertension and should be suggested to all patients to increase early detection and identify white-coat and masked hypertension.
Early therapeutical approaches:
While life-style measures such as body weight reduction, low-salt diet, physical exercise, and good sleep hygiene should be first-line treatments for all patients with hypertension, the benefit of pharmacologic treatment for BP reduction should be evaluated in relationship to atherosclerotic CVD (ASCVD) risk (see 2017 Guideline for High Blood Pressure in Adults).
Next to pharmacological treatment, other innovative neuromodulatory approaches are emerging that could help manage hypertension even in its early stages. Parasym device has been successfully used in the first RCT investigating the effect of transauricular VNS in young patients with grade 1 essential hypertension.
The study confirmed the hypotheses and showed that one hour a day of auricular vagal neuromodulation therapy delivered through the Parasym device led to significant BP reduction in 30 days.
Parasym effectiveness is thought to be mediated by decrease in sympathetic tone and related vascular resistance as well as by activation of the cholinergic anti-inflammatory pathway and decrease in vascular wall inflammation and reactivity. Due to the heightened susceptibility of young individuals to sympathetic nervous system imbalance, AVNT holds great potential in controlling BP particularly in this otherwise healthy patient population.
Beside the mechanisms of action, this easily accessible device‐based intervention can be particularly useful to improve treatment outcomes by enhancing psychological acceptance and improving adherence to treatment.
As data show that the younger the age of hypertension onset, the stronger the association with future cardiovascular events and all-cause mortality, the availability of an effective and safe approach in this population makes AVNT by Parasym a highly promising treatment option.