GSBSE Faculty Merrill Elias publishes on Hypertension

Two invited peer review editorials published by Merrill F. Elias and colleagues in May and June, were motivated by two important current themes in the treatment of high blood pressure: (1) intensive lowering of blood pressure to a new goal for management of arterial hypertension; (2) delayed response (lowering of BP to traditional levels) results in increased risk for cardiovascular disease, cerebral-vascular disease and death. The articles are:

 Elias MF, Torres RV, Davey A. Intensive blood pressure control improves cognitive performance: pushing the envelope cum judicia. Am J Hypertens. 2017;30:556–558. doi: 10.1093/ajh/hpx043.

 Elias, M. F & Torres, R. V. Delayed response to antihypertensive medication: a harbinger of stroke, heart failure, and vascular disease. Hypertension; 2017: DOI: 10.1161/HYPERTENSIONAHA.117.09306.

The first paper published in the American Journal of Hypertension is in response to a paper in the same journal indicating the benefits to cognitive performance of lowering BP levels from the traditional 140/90 mmHg to a more intensive treatment standard of 120 mmHg for systolic pressure (the top number). The authors comment that further lowering of blood pressure to this intensive control level is not without risk of adverse side effects in some individuals and that this goal needs to be pursued with maximum information about the patients’ histories as thorough histories might be predictive of side effects.

 The second editorial was in response to a paper in the same issue of Hypertension presenting data indicating that a delayed response to treatment, even if ultimately controlled, was related to adverse cardiovascular disease outcomes including stroke. Elias and Torres review a number of proposed reasons to account for the delayed response to treatment in some individuals, e.g. genetic differences in response to treatment, and a “one size fits all” approach that often fails to tailor the selection of drugs to the mechanisms underlying various types of hypertension.

This personalized approach to treatment is more costly than structured step-care approaches but the cost of diagnosis has to be weighed against the cost of treating cardiovascular and cerebrovascular consequences of delayed response to treatment or complete failure to lower blood pressure.

 Merrill F. (Pete Elias) is Professor of Psychology and Cooperating Professor in the Graduate School of Biomedical Sciences and Engineering, University of Maine. Rachael A. Torres, a graduate of the Psychology Department at the University of Maine, is currently a graduate student in the Department of Kinesiology and Applied Physiology, College of Health Sciences, University of Delaware. Adam Davey is Professor of Behavioral Health and Nutrition, College of Health Sciences, University of Delaware and Vice President for Research, Starr Laboratory, University of Delaware. All authors are members of the Maine-Syracuse Longitudinal Study research team, University of Maine.