Hypertension 2019 Wrap Up
Hypertension 2019 Wrap Up
Curt Sigmund, PhD, vice chair of the Council on Hypertension and Jan Basile, vice chair of clinical programs recap some of the highlights of Hypertension 2019, including several clinical debates and basic science topics.
Content
1.95 -> [Music]
3.41 -> hi Curt Sigmund Hyrum vice-chair of the
7.109 -> Council on hypertension and I'm joined
9.09 -> by Jan basil who is the vice chair for
12 -> clinical programs on the Council of
14.13 -> hypertension and we're here in New
16.26 -> Orleans for the hypertension sessions
19.16 -> 2019 meeting it's really been an
22.02 -> incredible meeting this year I'm really
24.539 -> excited about the program we've been
26.099 -> getting really positive comments from
28.83 -> the attendees and I'm wondering Janet if
31.17 -> there's anything that really struck you
32.85 -> is particularly fascinating from this
35.67 -> year's program Curt I am just delighted
37.71 -> without the program went down couldn't
40.829 -> have asked for more from the program
42.39 -> committee we had a number of great
44.96 -> debates and the most important maybe an
48.69 -> controversial debate was between Bob
50.789 -> Kerry and Sanjay call and Sanjay call
54.32 -> believed that the less than 130 over 80
57.449 -> target should not be the target
59.219 -> recommended and Bob Kerry felt it should
62.16 -> be and Sanjay felt too much information
64.53 -> was placed on the Sprint trial within
66.93 -> the overall analysis and Bob Kerry
69.42 -> showed many meta analyses including and
72.75 -> not including the Sprint trial that
74.939 -> still showed that less than 130 over 80
77.64 -> is the best target for patients with
79.68 -> hypertension that was exciting then we
82.439 -> had another exciting debate between Paul
84.689 -> Welton and Brian Williams on which drugs
86.7 -> should be given first dr. Welton went
89.28 -> through the evidence and believed that
91.74 -> either a thiazide like diuretic a cc B
94.799 -> or an ace or an R but not both should be
97.11 -> the first drug and Brian Williams said
99.689 -> forget about it we're recommending in
102.329 -> the ESC to drugs as initial therapy so I
105.84 -> don't even want to debate which first
108.149 -> drug is best that was awesome
110.61 -> we talked about blood pressure
112.17 -> measurement it all starts with the
114 -> measurement everything we do for our
116.009 -> patients is based on the measurement we
118.14 -> talked about office blood pressure as a
120.149 -> screening test home blood pressure as a
123.479 -> confirmatory test and how important home
126.869 -> blood pressures are to monitor and
129.509 -> follow-up our patients with hypertension
131.76 -> although ambulance
133.28 -> blood pressure is still the best
135.35 -> predictor of events but daytime
138.28 -> ambulatory and home blood pressure
141.55 -> correlate very well with one another so
144.41 -> when you can't get an A B p.m. home
146.84 -> blood pressure will be an important
149.09 -> measuring device big session on women
153.56 -> and hypertension and very important
157.15 -> basically women are treated similarly to
160.49 -> men in hypertension and the targets are
162.95 -> the same we talked about pregnancy and
165.35 -> hypertension labetalol hydralazine and
169.51 -> alpha methyl dopa are the three drugs no
172.67 -> wrasse blocker there was some
174.29 -> controversy about still using methyl
176.48 -> dopa but it's still on the list and is
178.85 -> still recommended as one of the three we
181.58 -> talked about diabetic hypertension that
184.19 -> was very interesting and the importance
186.35 -> of sglt2 inhibitors and glp-1 receptor
189.02 -> agonists
189.95 -> the first more significant blood
192.98 -> pressure reduction than with the glp-1
195.29 -> receptor agonists
196.64 -> you get a little weight loss you get a1c
199.07 -> control to prevent heart failure to
201.739 -> prevent and control renal disease and
204.47 -> the ESC has just moved glp-1 receptor
208.97 -> agonist and sglt2 inhibitors to be used
214.16 -> before metformin while we still say in
216.95 -> the diabetic metformin first very very
219.23 -> exciting then finally just a word on
221.09 -> resistant hypertension if you have
223.61 -> patients with resistant hypertension you
225.829 -> have to make sure they're adherent to
228.049 -> therapy before you call them truly
230.48 -> resistant and don't forget about the
232.61 -> importance of course a load on over
234.59 -> hydrochlorothiazide and
236.44 -> mineralocorticoid receptor antagonism
238.73 -> which drugs like Sparano lactone and or
241.43 -> a player a note or a meal arise as
243.29 -> additional drugs a lot of good
245.989 -> information for the clinician treating
248.03 -> patients with hypertension that's
249.56 -> fantastic can you the excitement is
251.87 -> palpable I could feel like thank and yet
254.48 -> we had a lot of really exciting programs
257.359 -> particularly in the recent advances
259.81 -> sessions this year where we really tried
262.4 -> very hard to describe both a basic
265.099 -> science concept and then
266.75 -> and the translational aspect to clinical
269.45 -> medicine which I thought was really
270.83 -> successful a good example of that was
274.58 -> the circadian rythms session and
276.98 -> chronobiology session doctor gums
280.07 -> provided some basic fundamental
282.31 -> mechanistic information on how clock
285.26 -> genes regulate our circadian rhythms
288.28 -> they discussed the aspects of the
292.49 -> dipping of blood pressure which occurs
294.91 -> nocturnally and then of course the
297.65 -> morning search in blood pressure which
299.96 -> is a risk factor for cardiovascular
303.19 -> mortality so we heard a lot about the
307.04 -> fundamental mechanisms and then dr.
309.68 -> Raman did an evidence-based discussion
313.82 -> of what is better for either a daytime
317.99 -> or nighttime administration event the
320.06 -> hypertensive therapy and and I think we
323.03 -> all recognize this remains a study under
325.94 -> active investigations and has not really
328.76 -> been fully settled but I think the idea
331.46 -> is if you can enhance the dipping
334.4 -> phenotype and mitigate some of that
338.36 -> morning surge and blood pressure may
340.79 -> mitigate risk along the way I know the
344.09 -> really exciting session were the session
347.63 -> on the microbiome and we had two
350.93 -> separate presentations on the microbiome
353.57 -> and then we also had a third talk on the
357.62 -> microbiome by dr. bina Joe who is our
360.26 -> Harry a Dustin awardee for the year and
363.11 -> it's becoming really clear how important
365.75 -> the microbiome is as you know that our
369.53 -> bodies are made up of about equal number
371.87 -> of cells of human cells and bacterial
374.54 -> cells and there's an incredible rich
376.61 -> richness to the bacterial diversity that
379.76 -> lives in our gut in fact there's a lot
381.71 -> more genomic information that's encoded
384.11 -> by the bacteria than it is from from
386.84 -> human genes and it's pretty clear that
389.59 -> our behaviors are a nutrition our
393.43 -> activity and of course the intake of
397.31 -> salt regulates
400.02 -> the type of bacteria that in our guts
402.33 -> and they make all kinds of metabolites
404.91 -> which influence our hosts us and have
408.9 -> influences on and on blood pressure so I
413.49 -> have a prediction that the microbiome is
416.49 -> going to be the next hot area of basic
418.74 -> science discovery in the council I think
421.62 -> it's going to be like in previous years
424.199 -> the surge that we saw in oxidative
425.97 -> stress mechanism is followed by the
428.4 -> surge in immune and inflammatory
430.91 -> mechanisms and in fact when you when you
433.65 -> look back on the studies of inflammation
437.099 -> and everything we now know dr. Nina
441.18 -> matera from Vanderbilt gave a great
443.34 -> presentation describing a development of
447.479 -> potential new therapeutics that it
449.55 -> directed at minimizing the damage that's
453.36 -> caused by the immune system in
455.039 -> hypertension but preventing any type of
459.229 -> overall immune function which will
462.479 -> compromise us in the case of you know
465.21 -> other diseases like colds and viruses
466.949 -> and things like that so I have a
469.02 -> suspicion that the next few years we'll
471.21 -> see a big increase in microbiome
473.25 -> research and it's very likely that we're
476.909 -> gonna see a lot more of that research
479.159 -> presented next year so with that I would
481.53 -> invite you to the hypertension sessions
483.84 -> 2020 which will be on September 10th to
487.38 -> 13th 2020 right here in New Orleans
489.87 -> again right we'll see you then
494.06 -> [Music]
499.38 -> you
Source: https://www.youtube.com/watch?v=cap33StlUsY