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REFLECTIONS
Hypertension
Hypertension Global Newsletter #8 2025

There was no statistically significant difference in the primary safety outcome. The absolute rates of discontinuation were 11 (2%) for
GMRx2, four (1%) for telmisartan-indapamide, three (1%) for telmisartan-amlodipine, and four (1%) for amlodipine-indapamide. Overall,
the safety profile was reassuring, with no excess of serious
Hypertension
adverse events, and most cases of electrolyte imbalance and
symptoms of hypotension were mild-to-moderate, consistent with CLICK HERE
a placebo-controlled comparison of this combination. TO LISTEN TO A JACC PODCAST
PRESENTED BY EDITOR-IN-CHIEF
This study was the first large-scale comparison of triple half- DR VALENTIN FUSTER TO DISCUSS
dose versus dual half-dose combinations of any polypill, THE CLINICAL RELEVANCE OF A
showing that the average triple versus dual blood pressure SINGLE PILL CONTAINING THREE BP-
reduction of 4.6/2.8 mmHg is clinically and statistically LOWERING AGENTS
significantly superior. The study findings show that GMRx2 led
to significantly lower home SBP and clinic blood pressure than
all dual combinations. Considering the necessity for patients to CLICK HERE
achieve and sustain lower blood pressure targets, the availability FOR THE LINK TO FULL ARTICLE
of an effective, safe, low-dose triple SPC represents an
important new therapeutic option for hypertension management.

SPECIAL POPULATIONS

Twelve hot questions in the management of hypertension in patients aged
80+ years and their answers with the help of the 2023 European Society of

Hypertension Guidelines
Bahat G, et al. J Hypertens. 2024 Nov 1;42(11):1837-1847.

Arterial hypertension affects almost 80% of those aged 80+ the impact of neurocognitive disorders and non-cardiovascular
years. As this population group grows, clinicians have an drugs on blood pressure, considerations for blood pressure
increasing number of older patients to care for and, therefore, monitoring methods, management of blood pressure variability,
must understand the challenges associated with hypertension frailty assessment, sex differences in management, non-
treatment in these older adults. The ESH working group pharmacological and pharmacological treatment strategies
(WG) on Hypertension in Older Adults composed a practical (initiation, uptitration, precautions), and situations where
paper to facilitate understanding of the 2023 Guideline’s antihypertensive treatment might be decreased.
recommendations on managing hypertension in older adults.
The authors of this article discuss the 12 important questions The article highlights several key messages, one of which is
on specific aspects mentioned concisely in these guidelines to the importance of recognising the heterogeneity of older adults.
clarify key features concerning this issue. This is vital for personalising their hypertension treatment by
integrating concepts like frailty and functional status, as the 2023
Following the 2023 ESH Guidelines on Hypertension presentation, ESH Guidelines recommended. The article notes that while all
the WG on Hypertension in Older Adults prepared a document five major antihypertensive drug classes (ACEis, ARBs, CCBs,
listing several questions commonly encountered in clinical practice thiazide/thiazide-like diuretics, and beta-blockers) can be used
while managing older adults. The process aimed to provide in older patients, specific considerations should be explored.
comprehensive and expert-informed answers, and the resulting
12 questions and answers were completed, reviewed, and For example, although evidence on the benefit of BP lowering
approved by the whole group. on cognitive decline has been conflicting, a recent individual
participant data meta-analysis of five randomised controlled
These questions cover a wide range of topics important to trials (RCTs) (28,008 patients, mean age 69.1 years) showed
managing hypertension in adults aged 80 years and older, that a SBP/DBP lowering of 10/4 mmHg was associated with
including the mechanisms and consequences of blood pressure a lower incidence of dementia (odds reduction of 13% after
evolution with age, the utility of cardiovascular risk evaluation, a median follow-up of 4.3 years), underlying the importance

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