Johan Sundström, MD, PhD after finding patients can have very different responses to different antihypertensive drugs.

Cardiology Pharmaceuticals

The Potential of Personalized Hypertension Medicine

A new study out of Sweden shows that people with hypertension can respond significantly better to some treatments than others, suggesting that hypertension medicine decisions might become far more personalized in the future.

It’s traditionally been challenging to get hypertension under control, in part because a single antihypertensive drug often doesn’t achieve sufficient BP reduction and many patients don’t want to add a second medication. 

• However, this new study suggests that hypertension control might be far less of a challenge if each patient was prescribed the optimal medication for them the first time around.

In the randomized, double-blind, repeated crossover trial, 280 Swedish people with grade 1 hypertension and low CV event risks were treated with four different blood pressure medications in random order (lisinopril, candesartan, hydrochlorothiazide, amlodipine). 

Data from 1,468 two-month treatment periods and 270 patients showed “substantial” variations in treatment responses between individuals (P < .001), finding that each participant’s optimal antihypertensive drug could reduce their systolic blood pressure by an additional 4.4 mm Hg compared to the study’s other treatment options. 

Each individual’s optimal antihypertensive drug also improved systolic blood pressure by…

• 3.1 mm Hg compared the group’s most effective overall treatment (lisinopril)
• 2-times compared to doubling the dosage of another antihypertensive option
• Over 50% compared to combining two different antihypertensive options

This new evidence that antihypertensive drugs have different effects on different patients could set the stage for larger RCTs to see if these findings can be replicated and to identify what factors influence treatment response variations. If successful, those trials might lead to big changes in hypertension treatment decisions.

The Takeaway

Although it might not be surprising that different patients respond better or worse to different medications, this study reframes what some might have historically described as standard deviation into an opportunity to start making hypertension treatment far more precise.

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The Wire

• Heart Research in Space: Astronauts and cosmonauts aboard the International Space Station spent last week performing experiments that might help us understand and treat “space-caused heart conditions and Earth-bound cardiac disorders.” The team used engineered heart tissue samples to explore how gravitational stresses affect cardiovascular cells and tissues, which will soon be returned to Earth for additional genetic analysis.

• Statins Reduce CVD in HIV Patients: The NIH’s large-scale REPRIEVE trial suggests that statins safely reduce CVD risks among people with HIV. Researchers randomized 7,769 HIV-positive people (ages 40-75) to either take a daily statin or a placebo, finding that statins reduced MACE risks by 35% with the same levels of adverse drug events as the general population. Chronic diseases like CVD have become leading causes of morbidity and mortality in this population as HIV treatments become more effective, creating the need for new heart disease guidelines for people with HIV.

• Genetesis’ 2nd Breakthrough Designation: The FDA granted Genetesis’ CardioFlux magnetocardiography (MCG) imaging system Breakthrough Device Designation for identification of myocardial ischemia in patients with suspected coronary microvascular disease (CMD), a disease that’s historically been hard to identify due to a lack of effective functional diagnostics. This is the CardioFlux’s second Breakthrough Designation, joining a previous designation for identifying myocardial ischemia and infarction in patients with suspected acute coronary syndrome, and serves as another milestone as Genetesis’ innovative MCG scanner progresses towards FDA clearance.

• Blood Pressure’s Dementia Link: A new JAMA Network Open study revealed a link between early-life hypertension and later-life brain health. Researchers performed brain MRI exams on 427 adults older than 50, finding that those who had hypertension when they were young tended to have lower regional brain volumes and poorer white matter integrity. The findings are in line with other studies showing that modifiable risk factors early in life can lead to Alzheimer’s disease and other dementias.

• CMS Inpatient Hike Falls Flat: CMS is proposing a 2.8% increase in payment rates in 2024 for the Inpatient Prospective Payment System, which covers Medicare reimbursement for inpatient hospital care. CMS says this increases hospital payments by $3.3 billion, but the American Hospital Association called it “woefully inadequate” considering the economic pressures hospitals are facing and the fact that half of hospitals finished 2022 in the red.

• No One-Size-Fits-All Approach: A new AHA scientific statement called for changes in the way we assess women’s heart disease risk, suggesting that the current “one-size-fits-all approach” isn’t sufficient for women. The statement detailed the non-biological factors that affect each woman’s risk profile (e.g. race, ethnicity, socioeconomics), but aren’t represented in current CVD risk assessment tools, while also noting that current methods don’t account for sex-specific biological factors, medications, or conditions that are more common among women.

• Hospital CEO Turnover Up 58%: It’s been a tough stretch for healthcare execs, but it’s still surprising to see that 41 hospital CEOs exited their roles in January and February alone. That figure’s from a Challenger, Gray & Christmas report, which found a 58% year-over-year increase in hospital CEO departures. More departures are likely on the way as hospitals “recover from the pandemic, consolidate, and respond to both worker shortages and increased costs.”

• Dapagliflozin Equally Effective: A pooled analysis of the DAPA-HF and DELIVER trials revealed that the SGLT2 inhibitor dapagliflozin (AstraZeneca’s Farxiga & Forxiga) achieved consistent benefits for both Black and White patients, although Black patients benefited more due to their higher absolute risks. At baseline, Black patients experienced a higher rate of worsening heart failure or cardiovascular death than White patients (16.8 vs. 11.6 per 100 person-years), but dapagliflozin similarly reduced risks in both groups (HR: 0.69 vs. 0.73).

• Transcatheter Arterialization Prevents Amputation: A study of 105 patients with chronic limb-threatening ischemia and no revascularization options found that transcatheter arterialization of the deep veins was safe and effective in preventing amputation. The study achieved technical success among 99% of patients, with 66% achieving amputation-free survival at 6 months (exceeding the study’s 54% goal). Limb salvage was attained in 76% of patients, and wounds were completely healed or were in the process of healing in the majority of patients (25% & 51%). Researchers didn’t report any unanticipated device-related adverse events.

• BioVentrix Adds $48.5M: Heart failure treatment startup BioVentrix wrapped up a $48.5M Series A funding round to support the Premarket Approval of its Revivent TC TransCatheter Ventricular Enhancement System and prepare for its commercial launch. Intended to treat patients with ischemic HFrEF and extensive left ventricular scar who haven’t responded to guideline therapies, the Revivent TC procedure employs myocardial micro-anchor implants to reconstruct the dilated left ventricle, resulting in a more efficient chamber. 

• Wireless Pacemakers Safe & Effective for Kids: The wireless pacemakers that have been used by adults for years might also be safe and effective for children with congenital heart disease. A Children’s Hospital of Philadelphia retrospective study analyzed data from 63 pediatric patients (all ≤21yrs) who were implanted with transcatheter leadless pacemakers, finding that 62 of the procedures were successful, and 10 complications occurred over a median follow-up of 9.5 months (no deaths, infections, or device embolizations).

PIA Medical Processes It All

Need an analysis like calcium scoring, strain or even FFR? PIA Medical began as a Core Lab and can handle creative cardiac research and clinical trials along with the full breadth of clinical analyses available today.

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How can AI be mobilized to automate the fight against heart disease? Us2.ai President Yoran Hummel, PhD, discusses how echocardiography can be optimized in an interview on The Medical AI Podcast

Editor’s note: In last Monday’s coverage of HeartFlow’s Series F round, we incorrectly called Cleerly’s $223M raise in 2022 a Series B round when it was actually its Series C. We’ve corrected this error and appreciate everyone for understanding.