Scientists from Queen Mary University of London and Barts Health NHS Trust have successfully improved blood pressure control among patients with severe intolerance to antihypertensive medication - by using medicines in unconventional ways and treating patients with a 'stepped care' approach (where the most effective yet least intensive treatment is delivered to patients first).
The study, which is published today in the Journal of Clinical Hypertension and is supported by Barts Charity, devised a novel treatment strategy for 55 patients, involving fractional dosing with tablets (halving or quartering pills), liquid formulations of antihypertensive drugs and patch formulations of antihypertensive drugs - plus use of unlicensed drugs that lower blood pressure.
Blood pressure was significantly reduced among patients after just six months on the novel treatment strategy, and the results were sustained. Significantly, the patients experienced no debilitating side effects.
Dr Melvin Lobo, who led the study at Queen Mary University of London and is also Director of the Barts Health Blood Pressure Clinic, comments: "This is an entirely new concept in tackling high blood pressure. There has in the past been an emphasis - and even a blame culture - on proving that uncontrolled blood pressure is down to patients either forgetting or not wanting to take their tablets. Many of our patients have reported negative experiences with their doctors after complaining about drug side effects. Often the feeling is that reducing the health risks of patients with high blood pressure, such as stroke or heart attack, justifies the very serious drug intolerance that they can experience.
"We, however, took a different view. We understand that some patients feel forced to cease their treatment due to how wretched it makes them feel. And so we set about trying to help them get around side effects, as opposed to forcing them to take drugs they felt were poisoning them.
"Some patients have even contemplated suicide rather than continue with medications that cause severe adverse effects - that is how serious this issue is."
There are approximately 15 million individuals in the UK with high blood pressure. Around half of patients with hypertension stop taking their medication within 12 months of being prescribed antihypertensive drugs, and severe intolerance is found in 10 per cent of patients referred to the Barts Health Blood Pressure Clinic.
Such patients are at very high risk of stroke, heart attack and kidney failure due to uncontrolled high blood pressure and the need to find alternative ways of getting these patients' blood pressure under control is urgent.
Dr Lobo continues: "By using the medications we already have available and taking a personalised approach to prescribing these drugs - avoiding an 'off the shelf' regime - it allowed patients to tolerate increased numbers of medications and ultimately resulted in significant and long lasting lowering of blood pressure. The difference this has made to our patients' lives cannot be overstated."
"Blood pressure control is vital as a means of avoiding serious cardiovascular events such as heart attack and stroke. However, anti-hypertensive medication side effects are common and can be very debilitating, causing severe impact on quality of life. Patients should not have to suffer such side effects when there are alternative ways of treating them.
"We also urge clinicians to be more sympathetic towards their patients who report drug side effects - after all, high blood pressure is an asymptomatic condition and it is the drugs that can make patients symptomatic with adverse effects. For this our patients should not be culpable.
"We recommend people with intolerance to three or more high blood pressure drugs, who are struggling to control their blood pressure, be referred to our centre at Barts Health NHS Trust. We plan to extend our studies into primary care in order to widen our reach and broaden the impact of our findings."
For more information contact:
PR Manager (School of Medicine and Dentistry)
Queen Mary University of London
Tel: 020 7882 7943 / 07709 825 741
Dr Mel Lobo
Tel: 07780 700440
For patient interview requests, please contact:
Press and Social Media Officer
Barts Health NHS Trust
Tel: 020 7709 6509 / 07712 813 728
Notes to the editor
About Queen Mary University of London
Queen Mary University of London (QMUL) is one of the UK's leading universities, and one of the largest institutions in the University of London, with 20,260 students from more than 150 countries.
A member of the Russell Group, we work across the humanities and social sciences, medicine and dentistry, and science and engineering, with inspirational teaching directly informed by our research - in the most recent national assessment of the quality of research, we were placed ninth in the UK (REF 2014).
We also offer something no other university can: a stunning self-contained residential campus in London's East End. As well as our home at Mile End, we have campuses at Whitechapel, Charterhouse Square and West Smithfield dedicated to the study of medicine, and a base for legal studies at Lincoln's Inn Fields.
We have a rich history in London with roots in Europe's first public hospital, St Barts; England's first medical school, The London; one of the first colleges to provide higher education to women, Westfield College; and the Victorian philanthropic project, the People's Palace based at Mile End.
QMUL has an annual turnover of £350m, a research income worth £100m, and generates employment and output worth £700m to the UK economy each year.
About Barts Health NHS Trust:
With a turnover of £1.1 billion and a workforce of 14,000, Barts Health is the largest NHS trust in the country, and one of Britain's leading healthcare providers. The Trust's five hospitals - St Bartholomew's Hospital in the City, including the Barts Heart Centre, The Royal London Hospital in Whitechapel, Newham University Hospital in Plaistow, Whipps Cross University Hospital in Leytonstone and Mile End - deliver high quality compassionate care to the 2.5 million people of East London and beyond.
Journal of Clinical Hypertension