New research exploring “drugs, diet and delivery” options for optimizing outcomes in patients with hypertension was the focus of four late-breaking trials presented Nov. 11 at AHA 2023.

In the CRHCP trial, an innovative four-year blood pressure (BP) intervention program using trained village doctors in rural China significantly reduced systolic BP by an average of 22 mmHg in patients with hypertension. In addition, risk of all-cause dementia was reduced by 15%. Doctors initiated and titrated antihypertensive medications based on a simple treatment protocol that adjusted medication doses based on a target BP of less than 130/80 mm Hg. They also provided discounted and free medications to patients and conducted health coaching on lifestyle modifications, home BP measurement and medicine adherence.

“This is the first, large, randomized trial to demonstrate that lowering BP is effective in reducing the risk of dementia in people with high BP,” said Jiang He, MD, PhD. “These findings emphasize the importance of widespread adoption of more intensive BP control to reduce the global burden of dementia.”

Results from POP-HT found that women with high BP during pregnancy had lower BP nine months later if their BP was more tightly controlled the first few weeks after delivery, compared with women who received usual postpartum care. Additionally, improvements in BP control after delivery also resulted in fewer postpartum hospital readmissions for hypertension and long-term beneficial changes in the structure and function of the heart and blood vessels of the women who had received the intervention.

“We were surprised by the size and consistency of the BP reduction in the women who received the intervention. The benefits started to emerge within the first week or two after pregnancy, and the effect on BP persisted after the medication was stopped,” said Paul Leeson, MB, BChir, PhD. “If the reduction in BP we observed at nine months is sustained long-term, this could slow progression to needing treatment for hypertension by an average of up to a decade.”

In the randomized CARDIA-SSBP trial, researchers found that following a low-sodium diet involving reduced daily sodium intake by around 4,000 mg/day significantly lowered BP in 70-75% of adult participants between the ages of 50 and 75 years in as little as one week. This included reductions among people currently taking BP medications.

“High BP is the most common chronic disease condition in the world, and for the majority of adults, dietary sodium intake influences BP,” said Deepak K. Gupta, MD, MSCI, FACC. ““This [trial] reinforces the importance of reductions in dietary sodium intake to help control BP, even among individuals already taking medications for hypertension. Just as any physical activity is better than none for most people, any sodium reduction from the current usual diet is likely better than none.”

The phase 2 KARDIA-1 trial found that a single injection of the experimental medication zilebesiran safely and effectively lowered BP in adults with mild-to-moderate hypertension for up to six months. Specifically, participants who received single doses of zilebesiran had greater than 10 mm Hg reductions, on average, in 24-hour systolic BP and greater than 90% reductions in serum levels of AGT. At the three-month follow-up, the participants in groups that received the 300 mg and 600 mg doses of zilebesiran had 24-hour average systolic BP that was lowered by 15 mm Hg or more on average.

“Our study demonstrates that either quarterly or biannual doses of zilebesiran can effectively and safely lower BP in patients with uncontrolled hypertension,” said George L. Bakris, MD. “These results reinforce the potential of zilebesiran to provide sustained BP control, improve adherence to medication via infrequent dosing, and in turn, improve outcomes for people with high BP.”