Is a Global Singular Hypertension Treatment Guideline that Would Improve Hypertension Control Achievable?

Abstract

Approximately 1.5 billion people are hypertensive. We are suboptimally dealing with this pandemic. Less than 50% of these patients are controlled, and both mortality and morbidity are increasing, despite our wide variety of pharmacologic therapies and a multitude of guidelines. A recent comparison of the AHA/AHACDC, ESH/ESC, ASH/ISH, and NICE guidelines all recommend 4 main drug classes: Angiotensin-Converting Enzyme Inhibitors [ACEI), Angiotensin Receptor Blockers (ARB), Calcium Channel Blockers (CCB), and Diuretics; with no need to emphasize differences between drugs within each class. None recommend utilizing an assessment of the Sympathetic (S) and Parasympathetic (P) abnormalities we’ve identified over the past 14 years (frequently present) or using the results to identify which drug(s) to choose if S and P malfunction(s) are identified. Hypertension (HTN), by definition, is a hemodynamic disease, and there are major inter- and intra-class differences in the hemodynamic effects, which can be autonomically mediated, among the drugs we administer.