251randomized to the polypill exposed a significantly higher adherence than those
receiving usual care (70% vs. 47%; p < 0.001). The study showed no significant
differences in BP or LDL-C levels between groups, possibly due to the limited
power of the study.
Available clinical data aid the viability of the polypill in CVD prevention and
management but with a limited area. The role of the polypill in CV prevention has
been gradually described. Further research of the polypill is necessary, with the col-
lective results to have the potential power changing the face of health care across the
world.
Chronotherapy
Investigators have assessed whether chronotherapy – the strategy of bedtime, rather
than morning, dosing of antihypertensive medications – can have an influence on
the circadian rhythm of BP, including 24-h ambulatory BP control and the preva-
lence of non-dipping. In the study of 250 patients with resistant hypertension,
patients who were randomly selected to the strategy of modifying one drug but
administering the new drug at bedtime showed a statistically important ambulatory
blood pressure reduction (9.4/6.0 mmHg for systolic/diastolic BP, p < 0.001) com-
pared with the strategy of modifying one drug but continuing all medications in a
single morning dose [ 97 ]. The effect was greater on the nocturnal than on the diur-
nal mean BP, and the prevalence of non-dipping diminished from 84 to 43% over
the 12-week study period. The benefit of chronotherapy has also been showed in
resistant hypertension by moving all non-diuretic antihypertensive drugs from
morning to bedtime dosing without altering any medications or doses [ 98 ]. By this
way, chronotherapy gives an opportunity to enhance nocturnal BP control and the
non-dipper pattern without changing the total number of medications with CKD are
encouraging.
Device Therapy for Resistant Hypertension
Devices to treat resistant hypertension significantly aim the sympathetic nervous
system, which is recognized to contribute to the pathogenesis of necessary hyper-
tension and many forms of secondary hypertension [ 99 ] (Table 15.4). However,
these devices are not uniformly fruitful in treating resistant hypertension. Chronic
electrical stimulation of the carotid sinus nerves with a surgically implantable
device, which was designated to trigger baroreflex-mediated inhibition of sympa-
thetic nerve activity, has been indicated to decline blood pressure in 54% of patients
with resistant hypertension in a randomized, double-blind, parallel-designed clini-
cal trial (n = 181) [ 100 ]. However, enhanced blood pressure con control was also
examined in 46%of control group patients (n = 81) in whom the devices were
15 Public Health Efforts for Earlier Resistant Hypertension Diagnosis...