HYPERTENSION

Only about a third of people with hypertension reach the blood pressure goal of less than 140/90 mm Hg. One reason is that some doctors do not treat hypertension aggressively enough. In other cases, people do not take their medication as prescribed or do not adopt the recommended lifestyle changes. Regular visits to the doctor are also an important part of keeping blood pressure under control. People with Stage 1 Hypertension that are otherwise healthy should see their physician once every month until their blood pressure goal is reached. However, people with other health problems or Stage 2 Hypertension should visit their doctor more frequently—typically every two to four weeks. Once the blood pressure has been lowered to the desired level and/or has stabilized, doctor visits can usually be reduced to every three to six months, although people with other health conditions (such as diabetes or heart disease) may need to visit their doctor more often.

Medications

Antihypertensives are a type of drug used to treat high blood pressure. There are many different types of antihypertensive agents, and they work in different ways to lower blood pressure. Some remove extra fluid and salt from the body. Others relax and widen the blood vessels or slow the heartbeat. A person may respond better and have fewer side effects with one drug than with another. Some patients need more than one antihypertensive agent to lower their blood pressure.

Antihypertensive medications are divided into many different categories, each which works differently and causes different side effects:

          Diuretics (thiazide diuretics, potassium-sparing diuretics, loop diuretics, combination diuretics)
          Beta-Blockers
          Angiotensin Converting Enzyme Inhibitors (ACE)
          Angiotensin II Receptor Blockers (ARBs)
          Calcium Channel Blockers
          Alpha-Blockers
          Alpha-Beta-Blockers
          Central Agonists
          Vasodilators
          Aldosterone Receptor Antagonists
          Direct Renin Inhibitors
          Combination Drugs

Therapy

Medication compliance is critical. If a dose is missed or if the dosage amount is split, the person’s blood pressure can rise to dangerous levels, putting the person at risk for heart attack, stroke, heart failure and kidney failure.

Some over the counter, prescription drugs, and supplements can raise blood pressure and/or interfere with the effectiveness of high blood pressure medications. These drugs can include: steroids, non-steroidal anti-inflammatory drugs (NSAIDs), nasal decongestants and other cold remedies, diet pills, cyclosporine, erythropoietin, tricyclic antidepressants and monoamine oxidase inhibitors, etc.

It takes time to find the right dose. Different people can respond very differently to medications. Everyone has to go through a trial period to find out which medications work best with the fewest side effects. Time is required to adjust to a drug. This may take several weeks, but the results will generally yield a better clinical outcome.

Once stabilized, blood pressure should be monitored on a regular basis. A single high reading is not an immediate cause for alarm. If a reading is slightly or moderately higher than normal, blood pressure needs to be measured a few more times. If the reading remains slightly or moderately higher, then the person needs to consult their healthcare professional to verify if there is a health concern or whether there may be an issue(s) with the blood pressure monitor.

If blood pressure readings suddenly exceed 180/120 mm Hg, the person needs to wait five minutes and test again. If the readings are still unusually high, the doctor needs to be contacted immediately. The person is experiencing a hypertensive crisis.

If blood pressure is higher than 180/120 mm Hg and the person is experiencing signs of possible organ damage such as chest pain, shortness of breath, back pain, numbness/weakness, change in vision, difficulty speaking, the person needs to call 9-1-1.

The concerns regarding antihypertensive drug therapy highlight the importance of primary prevention of hypertension combined with accurate elucidation of the blood pressure (BP) profile. Hypertensive patients presenting to clinical practice should be routinely screened for orthostatic hypotension; and white coat hypertension should be ruled out. Interventions that lower DBP (Diastolic Blood Pressure is the pressure in the arteries when the heart rests between beats) below 60 mmHg, exacerbations of postural hypotension (aka orthostatic hypotension) and complications associated with polypharmacy contribute to increased risk of falls and/or fractures (in the elderly).

Falls

Falls are one of the most common health concerns facing elderly persons today. About one-third of community-dwellers over the age of 65 and nearly one-half of institutionalized persons or persons over the age of 80 will fall each year. Almost half of fallers will experience a repeat fall within the next year. While most falls result in no injury, 31% of falls result in an injury requiring medical attention or restriction of activities for at least one day. Most of these are minor soft tissue injuries, but 10-15% of falls result in fracture, and 5% of falls result in more serious soft tissue injury or head trauma. Among nursing home residents, the incidence of major soft tissue injury or fracture related to a fall is twice that found in community dwelling elderly.

Falls may have other important consequences, even among elders without a fall-related injury. Falls are associated with greater functional decline, social withdrawal, anxiety and depression, and an increased use of medical services. Fear of falling is common among elderly fallers, and fear of falling has been associated with impaired mobility and decreased functional status. As a result, older adults who have fallen are at greater risk of becoming institutionalized regardless of whether they have experienced an injurious fall.

The total cost of fall-related injuries to the U.S. Health care system is substantial. Almost 8% of persons over the age of 70 will seek medical care in the emergency room secondary to a fall-related injury, and about one-third of these persons will be admitted to the hospital. In 2000, the U.S. health care system spent $19 billion on the direct medical costs of fall related injuries. Hip fractures alone, which are commonly associated with falls, cost the U.S. health care system over $8.7 billion per year.

Although fall-related injuries are not a common cause of death in the elderly, accidental falls are the leading cause of unintentional injury deaths in those aged over 65 years. Death related to falls increases with advancing age and greater number of co-morbidities. Certain fall-related injuries, such as hip fractures, are associated with a high mortality within the first six months, particularly in men.

The only cardiac medications that were associated with falls were diuretics, Type Ia anti-arrhythmic drugs (e.g. procainamide), and digoxin. The causes of orthostatic hypotension include the following which means a patient who is already hypotensive may be put at risk if they continue to take their antihypertension Medication:

•   Aging (orthostatic hypotension is more common in older people)
•   Hypovolemia (a drop in the volume of blood) and dehydration (low fluid volume in the body). Common causes of these are bleeding, elevated sugar, diarrhea, vomiting, and medications like thiazide diuretics (HCTZ) and loop diuretics (furosemide, bumetanide)
•   Dehydration (low fluid volume in the body)
•   Immobility (for instance, staying in bed for a long time)
•   Pregnancy
•   Heart conditions, including heart attack, heart failure, irregular heart rhythm, and valve disease
•   Anemia (low red blood cell count)
•   Parkinson's disease
•   Diseases of the endocrine system, including diabetes, adrenal insufficiency, and thyroid conditions
•  Medications that are used to treat elevated blood pressure, such as beta blockers, calcium channel blockers, ACE inhibitors, nitrates, and angiotensin II blockers. Patients who are at risk for this are those with conditions listed above (for example, diabetes, Parkinson’s)
•   Other medications for anxiety, depression, erectile dysfunction, or Parkinson's disease
•  Substances that are taken at the same time as blood pressure medications, such as alcohol, barbiturates, and other medications
•   Hot weather

This means that the person needs to talk with their doctor/care giver to ascertain whether to skip the dose and the next steps as care has to be taken before stopping an antihypertensive Medication.

ACCOY

ACCOY is developing patents pending combination NDA approved ACCOY System plus a drug antihypertensives that:

•   Assists the prescriber in ascertaining if the antihypertensive is effective in lowering the patient’s hypertension.
•  Monitor’s the patient’s blood pressure throughout the day, whether awake or asleep, whether resting, working, or exercising – providing a true picture of the patient’s blood pressure – enabling better medication/blood pressure management.
•   Assists in dose titration.
•   Screens for possible concomitant drug interactions.
•   Monitors, on a real-time basis, blood pressure control.
•   Assists in the identification of lifestyle, exercise and diet on the patient’s blood pressure.
•   Alerts prescribers if something has changed that is affecting the antihypertensive’s ability to lower the patient’s blood pressure (versus prior efficacy).
•   Alerts the patient and caregivers if the patient is having a hypertensive crisis.
•   Identifies hypotension.
•   For certain antihypertensives, e.g., diuretics, digoxin, etc., prevents falls by precluding dispensing a dose that will make the patient hypotensive and prone to falling.
•   Ensures prescription compliance.

Furthermore, ACCOY antihypertensives allow the natural substitution of a pill bottle for a smart, app-controlled drug dispenser that transparently provides better medication and patient management while saving on the total cost of care.

Overview

About one of three U.S. adults—or about 75 million people—have high blood pressure. As of 2016, only about half (54%) of these people had their high blood pressure under control. Hypertension is highly prevalent in older age and accounts for a large proportion of cardiovascular (CV) morbidity and mortality worldwide. Clinical trials evidence supports the use of antihypertensive drugs in hypertensive patients due to benefits in reducing CV disease and mortality. Hypertension when untreated is associated with increased morbidity and mortality due to long-term complications that include cardiovascular, cerebrovascular and chronic kidney disease and possibly also cognitive decline and/or dementia. Conversely, a consistent J-curve relationship exists between low Diastolic Blood Pressure (DBP) and all-cause death - so it is important to ensure the blood pressure remains within a normal range/the person’s target range. Treatment of high blood pressure lasts for life.