James P. McGivern

Treatment of hypertension

SummaryIn the Munich Blood Pressure Study (MBS), a cross-sectional study (MBS I) with follow-up (MBS II) of a random sample of 3,198 citizens aged 30–69 (response rate, 69.3%), treatment and control of hypertension were examined.Of the actual hypertensives 59% (221) in MBS II (373) were on drug treatment and about two-thirds (150) of those being treated had controlled blood pressure (BP). Womens BP was better controlled than mens.Of the 221 treated hypertensives 85% (188) received types of drugs or drug combinations which were in accordance with the recommendations of the German Hypertension League. However, this did not apply to the prescribed dosages of the various drugs. Of the treated hypertensives 52% were either on a diuretic, on a beta-blocker, or on a combination of both drugs. Rauwolfia alkaloids combined with a diuretic were given to 27%.In 79% of the participants who had received a beta-blocker either alone or in combination with other antihypertensive agents and who still had high BP values, the prescribed beta-blocker dosage was below the recommended daily dose. Fatigue was the most frequently reported symptom, possibly attributable to antihypertensive drug treatment.Electrocardiographic signs of left ventricular hypertrophy were found less frequently in controlled hypertensives, in comparison to treated but uncontrolled hypertensives or untreated hypertensives.Treatment of hypertension includes implantation of the discharge portion(s) of a catheter and/or electrical stimulation electrode(s) adjacent the tissue(s) to be stimulated. Stimulation pulses, i.e., drug infusion pulses and/or electrical pulses, are supplied by one or more implanted stimulators, through the catheter and possibly also a lead, tunneled subcutaneously between the stimulator and stimulation site. A microstimulator(s) may also/instead deliver electrical stimulation pulses. Stimulation sites include the carotid sinus and carotid body, among other locations. Treatments include drugs used for acute and/or chronic treatment of hypertension. In a number of embodiments, a need for or response to treatment is sensed, and the electrical and/or infusion pulses adjusted accordingly.