Personalised blood pressure treatment (PHYSIC)
How do you get the best effect from medicines for high blood pressure? Is it by duplicating preparations, combining several different medications, or customising treatment?
Project description
In Sweden, just over one in three inhabitants, more than two million individuals, have high blood pressure. The proportion rises with age - and by the age of 65, more than half have hypertension. The problem in all of this is that half of those with high blood pressure are unaware of it. Only one in five Swedes with high blood pressure manages to get their blood pressure under control with prescription medicines, and many walk around with untreated high blood pressure for a long time because it rarely or never causes any symptoms. This increases the risk of premature death, stroke, heart attack, kidney disease, heart failure, poor circulation in the legs and dementia. But how should the most commonly prescribed anti-hypertension medicines be used - is there any way to improve? Our research team has investigated this in a new study.
Today, it is actually a bit random what a patient gets for the first medicine for high blood pressure. As a doctor, you are often given a few favourite drugs that you have come to know over the years. You know what effect and side effects they can have, so you often start with one of them. At the same time, guidelines are increasingly saying that it is fine to start with two different drugs in combination, as most individuals need two or even three blood pressure drugs to keep their blood pressure in check.
Now our research team has investigated whether there is an optimal drug for each individual, allowing treatments to be tailored to each patient. The study involved 280 patients from Uppsala with high blood pressure. They were given four different medicines, from four drug groups, to try in turn over the course of a year. Participants underwent a total of seven 24-hour blood pressure measurements during the one-year study period - while they were not told which of the drugs they were on during this time.
Over time, we could see that the effect of the drugs varied greatly between patients. It was clear that some participants had lower blood pressure on one particular drug than on another. At the end of the study, patients were told which drug was suitable and most effective for them, which was their benefit from participating.
These unique study results were published in April in the prestigious journal JAMA, and have helped answer the question of whether there is potential for personalising treatments.
It was so clear that some patients responded better to one drug than the other - repeatedly. Each time they were given the drug that was most effective for them, they had a lower pressure than when they were given the other drug. A study like this, where participants had to try different drugs several times over several months, and then switch between them, has never been done before. The study design itself is a world first. This opens up the possibility of personalised treatment in the fight against high blood pressure. For example, doubling the dose of an ongoing drug treatment is likely to be less effective than finding the optimal drug.
The study has already been widely publicised in the media (including an interview on TV4 Nyhetsmorgon) and has already been quoted extensively.