Lancet paper today

A study from Prof Bryan Williams and colleagues in this week’s Lancet provides further insights into the pathophysiology of resistant hypertension – a condition in which BP remains un controlled despite treatment with at least 3 drugs and that affects about 500,000 people in the UK and over 100million people globally. In their PATHWAY2 study, they previously showed (Williams B Lancet 2015) that spironolactone, a 50yr old drug, could be repurposed to effectively treat this condition. In what has been described by this week’s Lancet editorial as a “landmark trial”, the PATHWAY2 study has already begun to change practice and treatment guidelines around the world.

This new study reports mechanistic data providing insights into the underlying pathophysiology of resistant hypertension, highlighting the advantage of embedding complex experimental medicine studies into trials, to better understand mechanisms. This new study demonstrates that resistant hypertension is predominantly a sodium retaining state, most probably driven in many cases by inappropriately high levels of aldosterone. The study team note that the current diagnostic criteria for primary aldosteronism are most likely too conservative and speculate that there are many cases of primary aldosteronism that go undetected with conventional diagnostic approaches. Prof. Williams stated: “the PATHWAY2 study has already begun to influence treatment guidelines around the world and this new data provides the template for future drug and diagnostic developments for resistant hypertension, by unravelling the underlying pathophysiology”. The studies were funded by the British Heart Foundation and the NIHR.

A study from Prof Bryan Williams and colleagues in this week’s Lancet provides further insights into the pathophysiology of resistant hypertension – a condition in which BP remains un controlled despite treatment with at least 3 drugs and that affects about 500,000 people in the UK and over 100million people globally. In their PATHWAY2 study, they previously showed (Williams B Lancet 2015) that spironolactone, a 50yr old drug, could be repurposed to effectively treat this condition. In what has been described by this week’s Lancet editorial as a “landmark trial”, the PATHWAY2 study has already begun to change practice and treatment guidelines around the world. This new study reports mechanistic data providing insights into the underlying pathophysiology of resistant hypertension, highlighting the advantage of embedding complex experimental medicine studies into trials, to better understand mechanisms. This new study demonstrates that resistant hypertension is predominantly a sodium retaining state, most probably driven in many cases by inappropriately high levels of aldosterone. The study team note that the current diagnostic criteria for primary aldosteronism are most likely too conservative and speculate that there are many cases of primary aldosteronism that go undetected with conventional diagnostic approaches. Prof. Williams stated: “the PATHWAY2 study has already begun to influence treatment guidelines around the world and this new data provides the template for future drug and diagnostic developments for resistant hypertension, by unravelling the underlying pathophysiology”. The studies were funded by the British Heart Foundation and the NIHR.