SAN FRANCISCO — Clues to the contents of long overdue hypertension guidelines and an update on renal denervation trials will be highlights here as the American Society of Hypertension meeting kicks off this week.
The program features data from the EnligHTN-1 trial outlining the first-in-man experience with the St. Jude renal denervation catheter, as well as data from the SYMPLICITY HTN-2 trial, which will give 30-month results with Medtronic’s version of the catheter.
The dramatic improvements in resistant hypertension in those uncontrolled trials sent out ripples through the cardiology community when first reported. Now the longer-term data are starting to come in to confirm whether the benefits are sustained and the procedure remains safe, conference chair William B. White, MD, noted in an interview with MedPage Today.
The program initially also featured a session on the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-8) guideline, but those recommendations continue to be delayed.
The work on the guidelines, which have been renamed JNC 2013, has been completed, as has the public review, noted White, who served as one of the external peer reviewers and is chief of hypertension and clinical pharmacology at the University of Connecticut in Farmingham.
But the National Heart, Lung, and Blood Institute decided to hold off on public release a little longer, turning the session into an unofficial look at the topics to be covered in the guidelines with some of its authors, rather than an official overview.
“We’re very disappointed about that,” White said. Still, the session should give some indication of where the JNC is going, he pointed out.
“These speakers will be talking about their views based on the evidence that is in the medical literature, and that same evidence is used to generate a guideline like the JNC,” he told MedPage Today. “There’s no other data, there is what there is.”
Yet some of the issues are “extraordinarily controversial,” he acknowledged, such as how low to go in the hypertensive diabetic since the ACCORD trial showed no advantage to 120 or 130 mm Hg over 140 mm Hg — as well as how to get there now that all the antihypertensives are on a level, generic playing field.
The plenary session on Thursday will tackle the issue of data in hypertension.
Leaders in the field will address some of the pitfalls of clinical trials in primary and secondary prevention and an argument for evaluation of some of the “softer” endpoints like cost-effectiveness and quality of life in trials.
Why another big, federally supported hypertension trial is still justified after ACCORD will be addressed by William Cushman, MD, of the Veterans Affairs Medical Center in Memphis, Tenn.
His group is undertaking just such a trial, dubbed SPRINT, to compare blood pressure lowering thresholds in chronic kidney disease.
“SPRINT is maybe one of the very last major clinical trials in hypertension that will be supported by the National Heart, Lung, and Blood Institute,” White suggested. “Being a very expensive study, do we need it or not?”
Source: MedPage Today.
