News From Pharmacy Times

Intensive Blood Pressure Control May Extend Life in Adults with Hypertension

A 50-year-old patient with high blood pressure (bp) could expect to live almost 3 years longer with more intensive BP control that is focused on a target systolic BP of <120 mm Hg, according to the results of a study presented at the American Heart Association’s Scientific Sessions 2019 in Philadelphia, Pennsylvania.¹

Globally, an estimated 1.13 billion individuals have hypertension, which causes about 13% of all deaths, according to the World Health Organization. Most of the time, no obvious symptoms are present, but certain lifestyle choices and physical traits put patients at greater risk.²

Preventive techniques such as BP control can prolong a patient’s life free from disability or disease, according to lead study author Muthiah Vaduganathan, MD, MPH, an instructor of medicine at Harvard Medical School in Boston, Massachusetts.²

A 65-year-old patient with high BP could extend their life by more than a year with intensive treatment, whereas an 80-year-old patient could be expected to add almost 10 months to their life span, results of the research showed.¹ The study results build on the 2015 findings of the landmark Systolic Blood Pressure Intervention Trial (SPRINT), which tested the value of treating BP intensively to reduce systolic readings to a target of <120 mm Hg instead of the routinely used target of <140 mm Hg.1 SPRINT enrolled 9361 middle-aged and older adults with systolic readings of 130 to 180 mm Hg who were at risk of heart disease but did not have diabetes.¹

At 1 year, the mean systolic BP was 121.4 mm Hg in the intensive-treatment group and 136.2 mm Hg in the standard-treatment group. The intervention was stopped early after a median follow-up of 3.26 years because of a significantly lower rate of myocardial infarction in the intensive-treatment group.¹

Targeting a systolic BP of <120 mm Hg compared with <140 mm Hg resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause, though investigators observed significantly higher rates of some adverse events in the intensive-treatment group. The intensive approach reduced patients’ risk of cardiovascular events

by 25%.¹—Jennifer Nessel

Reference

• A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med 2015; 373:2103-2116. DOI: 10.1056/NEJMoa1511939. Published November 26, 2015. https://www.nejm.org/doi/full/10.1056/NEJMoa1511939. Accessed November 13, 2019.
• Studies explore potential benefits and costs of increased treatment to achieve lower blood pressure targets [press release]. American Heart Association Scientific Sessions. Published November 11, 2019. https://newsroom.heart.org/news/studies-explore-potential-benefits-and-costs-of-increased-treatment-to-achieve-lower-blood-pressure-targets. Accessed November 13, 2019.

Study: Distribution of HIV Self-Tests Is Worthwhile Tool to Prevent Transmission and Raise Awareness

A randomized clinical trial published in JAMA Internal Medicine found that the distribution of HIV self-tests can help increase awareness of HIV infection and prevent future transmission, specifically among men who have sex with men (MSM).

The study’s objective was to evaluate the effect of HIV self-tests by the diagnoses of HIV infection, frequency of testing, and sexual risk behaviors. Over 12 months, the 2-group randomized clinical trial studied MSM who were recruited online between March and August 2015. The participants were at least 18 years, had not previously tested positive for HIV, and were US residents. Laboratory test results, quarterly online surveys, and telephone call notes were included in the analyses and were completed between August 2017 and December 2018.

Participants were randomized 1:1 to the control group and a self-testing (ST) group. Four HIV self-tests were completed. Upon completion of the study, all participants were offered 1 dried blood spot collection kit and 2 self-tests.

Of 2665 participants, 16.6% had never been tested for HIV before enrollment. More ST participants than control participants reported testing 3 or more times during the trial, whereas the cumulative number of newly identified infections during the trial was twice as high in the ST participant group than in the control group. In all, the ST participants reported 34 newly identified infections among social network members who used the self-tests.—Jill Murphy

Reference

MacGowan RJ, Chavez PR, Borkowf CB, et al. Effect of internet-distributed HIV self-tests on HIV diagnosis and behavioral outcomes in men who have sex with men [published online November 18, 2019]. JAMA Intern Med. doi: 10.1001/jamainternmed.2019.5222.

FDA Approves First Oral GLP-1 for Type 2 Diabetes

The FDA has granted approval of semaglutide oral tablets (Rybelsus; Novo Nordisk) 7 or 14 mg for the treatment of type 2 diabetes (T2D). The drug is the first oral glucagon-like peptide-1 (GLP-1) receptor protein treatment for T2D to receive FDA approval.¹

Along with diet and exercise, semaglutide oral tablets are indicated to improve control of blood sugar in adult patients. GLP-1 drugs are noninsulin treatments for patients with T2D.²

The efficacy and safety of the drug in reducing blood sugar were studied in 10 PIONEER clinical trials,² two of which were placebo controlled and several of which compared the agent with other GLP-1 injection treatments.1 In the 9543 enrolled participants, the drug was studied as a stand-alone therapy and in combination with other therapies, including insulins, metformin, sodium-glucose cotransporter 2 inhibitors, sulfonylureas, and thiazolidinediones.²

As a stand-alone therapy, semaglutide oral tablets resulted in a significant reduction in blood sugar compared with placebo, as determined through hemoglobin (Hb) A1C tests. After 26 weeks, 69% of those taking 7 mg once daily and 77% of those taking 14 mg

once daily decreased their HbA1C levels to lower than 7% compared with 31% of patients on placebo.1

The prescribing information includes warnings for the potential increased risk of acute kidney injury, diabetic retinopathy, hypersensitivity reactions, hypoglycemia, pancreatitis, and thyroid C-cell tumors. The prescribing information also includes a boxed warning that semaglutide oral tablets are not recommended as the first choice of medicine for treating diabetes.^1,2—Aislinn Antrim

REFERENCES

• FDA approves first oral GLP-1 treatment for type 2 diabetes. US Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/fda-approves-first-oral-glp-1-treatment-type-2-diabetes. Published September 20, 2019. Accessed September 20, 2019.
• FDA approves Rybelsus (semaglutide), the first GLP-1 analog treatment available in a pill for adults with type 2 diabetes. Novo Nordisk. https://222.novonordisk-us.com/media/news-releases.html?122973. Published September 20, 2019. Accessed September 20, 2019.