Optimizing cardiovascular health: innovative strategies in hypertension and atrial fibrillation management
27 Nov 2024
byJoanne G. Blanco, MD
The "Fight for Freedom: Joining Forces Against Cardiovascular Disease" symposium brought together key figures in cardiology to discuss the growing burden of cardiovascular disease (CVD) in the Philippines. Notable speakers included Dr Gilbert C. Vilela, an Examiner for the Philippine Board of Cardiology, and Dr Eugenio B. Reyes, Past President of the Philippine Heart Association. The event highlighted two of the most pressing cardiovascular challenges in the country today: hypertension and atrial fibrillation (AF).
Figure 1. The speakers and moderator of the event (from left): speakers Dr Gilbert C. Vilela, Examiner, Philippine Board of Cardiology; Dr Eugenio B. Reyes, Past President, Philippine Heart Association; and moderator, Dr Wilbert Allan G. Gumatay, Chair, Council on Heart Failure, Philippine Heart Association.
Hypertension, a significant economic burden, requires innovative management approaches
Dr Eugenio Reyes opened the symposium with a lecture on hypertension, describing it as a significant public health problem, especially in economically disadvantaged communities. With rising inflation and healthcare costs in the Philippines, access to effective treatment options for hypertension has become increasingly difficult. Hypertension is a leading cause of CVD and contributes to a wide array of complications, including stroke, heart attack, and chronic kidney disease (CKD).1,2
Dr Reyes emphasized the importance of staying updated with the latest hypertension management guidelines, which have been designed to address the varied needs of patients, particularly in lower-income populations. These guidelines promote individualized treatment approaches, recognizing that a one-size-fits-all solution is often inadequate for controlling blood pressure in diverse patient groups. The benefits of fixed-dose combination (FDC) therapies, which combine two or more antihypertensive agents into a single pill, were discussed. This approach not only improves treatment adherence but also simplifies medication regimens, which is crucial for patients managing multiple health conditions or dealing with the financial strain of purchasing multiple medications.3
In the Philippines, where out-of-pocket healthcare expenses are the norm, FDC therapies like the amlodipine-losartan combination have proven to be a cost-effective solution for hypertension management. Amlodipine, a calcium channel blocker, works to relax blood vessels and improve blood flow4, while losartan, an angiotensin II receptor antagonist, prevents blood vessels from narrowing.5
Together, these medications help control blood pressure while also reducing the risk of major cardiovascular events. Clinical studies have shown that amlodipine reduces the risk of heart attack, stroke, and cardiovascular death, while losartan has been shown to provide additional benefits, such as reducing the risk of stroke and slowing the progression of kidney disease in hypertensive patients.6,7
Figure 2. Blood pressure reduction with amlodipine/losartan 5/50 mg categorized based on baseline systolic blood pressure (SBP) and diastolic blood pressure (DBP) into quartiles.8
A post hoc analysis of four clinical trials compared blood pressure reductions between fixed-dose combination therapy with amlodipine/losartan and amlodipine monotherapy. Patients treated with amlodipine/losartan 5/50 mg showed significantly greater reductions in systolic and diastolic blood pressure compared with those on amlodipine 5 mg, and greater systolic reductions compared with amlodipine 10 mg. The odds of responding to therapy were significantly higher in patients on amlodipine/losartan 5/50 mg versus amlodipine 5 mg. These findings support early use of combination therapy for hypertension management.8
Dr Reyes stressed that the key to successful hypertension management is improving patient adherence to prescribed medications. Non-adherence remains a major challenge, often leading to poorly controlled blood pressure and higher rates of cardiovascular complications. By utilizing FDC therapies, physicians can make it easier for patients to stick to their treatment plans, thus, reducing the likelihood of cardiovascular events and improving overall outcomes.9
Anticoagulation therapy plays a crucial role in reducing stroke risk in AF
Dr Gilbert Vilela’s lecture focused on the management of AF, particularly the use of anticoagulation therapy to prevent stroke. AF is a common arrhythmia that significantly increases a patient’s risk of stroke. Dr Vilela highlighted the importance of proper stroke risk assessment in AF patients, especially those with comorbidities like hypertension, diabetes, and chronic kidney disease.10
The management of AF has evolved significantly over the years, with novel oral anticoagulants (NOACs) now being recommended as the first-line therapy for stroke prevention. Dr Vilela emphasized that NOACs, such as apixaban, offer a more effective and safer alternative to traditional anticoagulants like warfarin.11 Apixaban has been extensively studied in clinical trials, including the ARISTOTLE and AVERROES trials, which demonstrated its superiority in preventing stroke and reducing the risk of major bleeding compared with both warfarin and aspirin.11,12
The ARISTOTLE trial, which enrolled over 18,000 patients, showed that apixaban reduced the risk of stroke and systemic embolism more effectively than warfarin, with a significantly lower risk of major bleeding and death from all causes.11 Meanwhile, the AVERROES trial confirmed that apixaban is a safer and more effective alternative to aspirin in patients for whom warfarin is not suitable. These findings have established apixaban as a key treatment option for AF patients, offering both efficacy and safety.12
Figure 3. Forrest plot for effect of apixaban vs. warfarin for outcomes of stroke or systemic embolism, mortality, and major bleed according to renal function estimated with the Cockcroft–Gault equation. Apixaban was more effective and was associated with fewer major bleeding events than warfarin across all ranges of eGFR. Interaction P-values are based on categorical estimated glomerular filtration rates.15
One of the most challenging aspects of managing AF is treating patients with declining kidney function. As kidney function worsens, the risk of stroke and bleeding increases, making it difficult to balance the benefits and risks of anticoagulation therapy. However, Dr Vilela pointed out that apixaban has been shown to be effective and safe in patients with CKD. The ARISTOTLE trial found that apixaban’s benefits extend to AF patients across all ranges of renal function, including those with mild to moderate CKD. This makes apixaban a versatile and reliable option for a wide range of AF patients, regardless of kidney function.11
Addressing the cardiovascular burden in the Philippines requires targeted interventions for hypertension and AF
The symposium underscored the urgent need for improved management of both hypertension and AF in the Philippines. Hypertension remains a widespread issue, particularly in economically disadvantaged areas, where access to healthcare and medications is limited.13 FDC combination therapies like the amlodipine-losartan combination offer a practical and cost-effective solution for improving blood pressure control, reducing the risk of cardiovascular events, and improving patient adherence to treatment regimens.14
Meanwhile, AF poses a significant risk of stroke, particularly in patients with other comorbidities like diabetes and CKD. Apixaban, as a novel oral anticoagulant, offers an effective and safer alternative to traditional therapies like warfarin, providing superior protection against stroke while minimizing the risk of major bleeding. Its efficacy across all levels of kidney function further highlights its value as a first-line treatment for AF patients, including those with CKD.11,12
Innovative therapies, key to managing CVD
In conclusion, innovative therapies and individualized care are key to managing CVD in the Philippines. The "Fight for Freedom: Joining Forces Against Cardiovascular Disease" symposium provided valuable insights into the management of two of the most pressing cardiovascular challenges in the country: hypertension and AF.
The event’s theme of freedom symbolized the goal of liberating patients from the challenges of non-adherence, the constraints of inflation, and the burden of CVD. By offering solutions that include equally effective yet more economical medications, the symposium emphasized the importance of accessible healthcare. The speakers highlighted the critical role of FDC therapies and novel oral anticoagulants like apixaban in improving patient adherence, enhancing outcomes and reducing the financial strain on Filipino patients, ultimately advancing cardiovascular health nationwide.
References: 1. Fuchs FD, Whelton PK. Hypertension 2020;75(2):285-292. 2. Burnier M, Damianaki A. Circ Res 2023;132(8):1050-1063. 3. Parati G, et al. Hypertension 2021;77(2):692-705. 4. Bulsara KG, Patel P, Cassagnol M. Amlodipine. [Updated 2024 Apr 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519508/5. Mulla S, Patel P, Siddiqui WJ. Losartan. [Updated 2024 Feb 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526065/6. Katsiki N, et al. J Clin Hypertens (Greenwich) 2018;20(8):1153–9.7. Brenner BM, et al. N Engl J Med 2001;345(12):861-9. 8. Unniachan S, et al. J Clin Hypertens (Greenwich) 2014;16(9):671-7.9. Hamrahian SM, Maarouf OH, Fülöp T. Patient Prefer Adherence 2022;16:2749-2757.10. Wańkowicz P, Nowacki P, Gołąb-Janowska M. Arch Med Sci 2019;17(1):19-24.11. Granger CB, et al. N Engl J Med 2011;365(11):981–992.12. Connolly SJ, et al. N Engl J Med 2011;364(9):806-17.13. Elnaem MH, et al. Int J Environ Res Public Health 2022;19(21):14571.14. Kim SH, et al. BMC Res Notes 2011;4:461.15. Hohnloser et al. Eur Heart J 2012;22:2821-30.
5th Floor Jafer Building 118 West Avenue, Barangay Philam Quezon, Metro Manila, 1104 Philippines
Figure 1. The speakers and moderator of the event (from left): speakers Dr Gilbert C. Vilela, Examiner, Philippine Board of Cardiology; Dr Eugenio B. Reyes, Past President, Philippine Heart Association; and moderator, Dr Wilbert Allan G. Gumatay, Chair, Council on Heart Failure, Philippine Heart Association.
Hypertension, a significant economic burden, requires innovative management approaches
Dr Eugenio Reyes opened the symposium with a lecture on hypertension, describing it as a significant public health problem, especially in economically disadvantaged communities. With rising inflation and healthcare costs in the Philippines, access to effective treatment options for hypertension has become increasingly difficult. Hypertension is a leading cause of CVD and contributes to a wide array of complications, including stroke, heart attack, and chronic kidney disease (CKD).1,2
Dr Reyes emphasized the importance of staying updated with the latest hypertension management guidelines, which have been designed to address the varied needs of patients, particularly in lower-income populations. These guidelines promote individualized treatment approaches, recognizing that a one-size-fits-all solution is often inadequate for controlling blood pressure in diverse patient groups. The benefits of fixed-dose combination (FDC) therapies, which combine two or more antihypertensive agents into a single pill, were discussed. This approach not only improves treatment adherence but also simplifies medication regimens, which is crucial for patients managing multiple health conditions or dealing with the financial strain of purchasing multiple medications.3
In the Philippines, where out-of-pocket healthcare expenses are the norm, FDC therapies like the amlodipine-losartan combination have proven to be a cost-effective solution for hypertension management. Amlodipine, a calcium channel blocker, works to relax blood vessels and improve blood flow4, while losartan, an angiotensin II receptor antagonist, prevents blood vessels from narrowing.5
Together, these medications help control blood pressure while also reducing the risk of major cardiovascular events. Clinical studies have shown that amlodipine reduces the risk of heart attack, stroke, and cardiovascular death, while losartan has been shown to provide additional benefits, such as reducing the risk of stroke and slowing the progression of kidney disease in hypertensive patients.6,7
Figure 2. Blood pressure reduction with amlodipine/losartan 5/50 mg categorized based on baseline systolic blood pressure (SBP) and diastolic blood pressure (DBP) into quartiles.8
A post hoc analysis of four clinical trials compared blood pressure reductions between fixed-dose combination therapy with amlodipine/losartan and amlodipine monotherapy. Patients treated with amlodipine/losartan 5/50 mg showed significantly greater reductions in systolic and diastolic blood pressure compared with those on amlodipine 5 mg, and greater systolic reductions compared with amlodipine 10 mg. The odds of responding to therapy were significantly higher in patients on amlodipine/losartan 5/50 mg versus amlodipine 5 mg. These findings support early use of combination therapy for hypertension management.8
Dr Reyes stressed that the key to successful hypertension management is improving patient adherence to prescribed medications. Non-adherence remains a major challenge, often leading to poorly controlled blood pressure and higher rates of cardiovascular complications. By utilizing FDC therapies, physicians can make it easier for patients to stick to their treatment plans, thus, reducing the likelihood of cardiovascular events and improving overall outcomes.9
Anticoagulation therapy plays a crucial role in reducing stroke risk in AF
Dr Gilbert Vilela’s lecture focused on the management of AF, particularly the use of anticoagulation therapy to prevent stroke. AF is a common arrhythmia that significantly increases a patient’s risk of stroke. Dr Vilela highlighted the importance of proper stroke risk assessment in AF patients, especially those with comorbidities like hypertension, diabetes, and chronic kidney disease.10
The management of AF has evolved significantly over the years, with novel oral anticoagulants (NOACs) now being recommended as the first-line therapy for stroke prevention. Dr Vilela emphasized that NOACs, such as apixaban, offer a more effective and safer alternative to traditional anticoagulants like warfarin.11 Apixaban has been extensively studied in clinical trials, including the ARISTOTLE and AVERROES trials, which demonstrated its superiority in preventing stroke and reducing the risk of major bleeding compared with both warfarin and aspirin.11,12
The ARISTOTLE trial, which enrolled over 18,000 patients, showed that apixaban reduced the risk of stroke and systemic embolism more effectively than warfarin, with a significantly lower risk of major bleeding and death from all causes.11 Meanwhile, the AVERROES trial confirmed that apixaban is a safer and more effective alternative to aspirin in patients for whom warfarin is not suitable. These findings have established apixaban as a key treatment option for AF patients, offering both efficacy and safety.12
Figure 3. Forrest plot for effect of apixaban vs. warfarin for outcomes of stroke or systemic embolism, mortality, and major bleed according to renal function estimated with the Cockcroft–Gault equation. Apixaban was more effective and was associated with fewer major bleeding events than warfarin across all ranges of eGFR. Interaction P-values are based on categorical estimated glomerular filtration rates.15
One of the most challenging aspects of managing AF is treating patients with declining kidney function. As kidney function worsens, the risk of stroke and bleeding increases, making it difficult to balance the benefits and risks of anticoagulation therapy. However, Dr Vilela pointed out that apixaban has been shown to be effective and safe in patients with CKD. The ARISTOTLE trial found that apixaban’s benefits extend to AF patients across all ranges of renal function, including those with mild to moderate CKD. This makes apixaban a versatile and reliable option for a wide range of AF patients, regardless of kidney function.11
Addressing the cardiovascular burden in the Philippines requires targeted interventions for hypertension and AF
The symposium underscored the urgent need for improved management of both hypertension and AF in the Philippines. Hypertension remains a widespread issue, particularly in economically disadvantaged areas, where access to healthcare and medications is limited.13 FDC combination therapies like the amlodipine-losartan combination offer a practical and cost-effective solution for improving blood pressure control, reducing the risk of cardiovascular events, and improving patient adherence to treatment regimens.14
Meanwhile, AF poses a significant risk of stroke, particularly in patients with other comorbidities like diabetes and CKD. Apixaban, as a novel oral anticoagulant, offers an effective and safer alternative to traditional therapies like warfarin, providing superior protection against stroke while minimizing the risk of major bleeding. Its efficacy across all levels of kidney function further highlights its value as a first-line treatment for AF patients, including those with CKD.11,12
Innovative therapies, key to managing CVD
In conclusion, innovative therapies and individualized care are key to managing CVD in the Philippines. The "Fight for Freedom: Joining Forces Against Cardiovascular Disease" symposium provided valuable insights into the management of two of the most pressing cardiovascular challenges in the country: hypertension and AF.
The event’s theme of freedom symbolized the goal of liberating patients from the challenges of non-adherence, the constraints of inflation, and the burden of CVD. By offering solutions that include equally effective yet more economical medications, the symposium emphasized the importance of accessible healthcare. The speakers highlighted the critical role of FDC therapies and novel oral anticoagulants like apixaban in improving patient adherence, enhancing outcomes and reducing the financial strain on Filipino patients, ultimately advancing cardiovascular health nationwide.
References: 1. Fuchs FD, Whelton PK. Hypertension 2020;75(2):285-292. 2. Burnier M, Damianaki A. Circ Res 2023;132(8):1050-1063. 3. Parati G, et al. Hypertension 2021;77(2):692-705. 4. Bulsara KG, Patel P, Cassagnol M. Amlodipine. [Updated 2024 Apr 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519508/5. Mulla S, Patel P, Siddiqui WJ. Losartan. [Updated 2024 Feb 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526065/6. Katsiki N, et al. J Clin Hypertens (Greenwich) 2018;20(8):1153–9.7. Brenner BM, et al. N Engl J Med 2001;345(12):861-9. 8. Unniachan S, et al. J Clin Hypertens (Greenwich) 2014;16(9):671-7.9. Hamrahian SM, Maarouf OH, Fülöp T. Patient Prefer Adherence 2022;16:2749-2757.10. Wańkowicz P, Nowacki P, Gołąb-Janowska M. Arch Med Sci 2019;17(1):19-24.11. Granger CB, et al. N Engl J Med 2011;365(11):981–992.12. Connolly SJ, et al. N Engl J Med 2011;364(9):806-17.13. Elnaem MH, et al. Int J Environ Res Public Health 2022;19(21):14571.14. Kim SH, et al. BMC Res Notes 2011;4:461.15. Hohnloser et al. Eur Heart J 2012;22:2821-30.
5th Floor Jafer Building 118 West Avenue, Barangay Philam Quezon, Metro Manila, 1104 Philippines