The STITCH study: hypertension management made simple

“Less is better” might be the new strategy in treating high blood pressure, according a study by Canadian researchers. The study called “Simplified Treatment Intervention to Control Hypertension” (STITCH) was conducted by researchers at the Robarts Research Institute of the University of Western Ontario. The study followed up 2,104 participants with high hypertension, basically patients from 45 family practices in southwestern Ontario, Canada.

There are many different guidelines of the management of hypertension depending on the country and the medical group you are talking to. They can be complicated and confusing and can be challenging to both patients and doctors alike. Furthermore, they are frequently updated and amended.

The objective of the STITCH study is “to see if there are simpler ways to help patients (and their doctors) reduce their blood pressure to goal levels than by following national guidelines which can be complicated.”

The STITCH study came up with the following simplified treatment regime:

(1) initial therapy with a low-dose angiotensin-converting enzyme (ACE) inhibitor/diuretic or angiotensin receptor blocker/diuretic combination;

(2) up-titration of combination therapy to the highest dose;

(3) addition of a calcium channel blocker and up-titration; and

(4) addition of a non-first-line antihypertensive agent.

The results of the study suggest that starting with low doses of combination drug, then gradually increasing may actually be better for recently diagnosed hypertensive patients. “A half tablet of a single pill combination drug (e.g. an ACE-inhibitor/diuretic or angiotensin receptor blocker/diuretic combination) than the regular starting dose of a single drug” may actually be more effective. The results of the study will be published in the April edition of the journal Hypertension.

High blood pressure is a risk factor for heart disease and stroke. According to the most recent estimates (source: American Heart Association), one in three Americans have high blood pressure.

Aside from pharmacological therapy, lifestyle changes are necessary to prevent, manage and control high blood pressure. Some of these lifestyle changes are (Source: American Heart Association Scientiific Advisory):

• Weight Loss
• Dietary Salt Restriction
• Moderation of Alcohol Intake
• Increased Physical Activity
• Ingestion of a High-Fiber, Low-Fat Diet

Honestly, even the “simplified” treatment regime of the STITCH study doesn’t look that simple to me. I’d rather go for the lifestyle changes and got for prevention.

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