Hypertension treatment offers challenges beyond blood pressure control
17 May each year marks World Hypertension Day, encouraging an increase in awareness and control of this modern epidemic.
While the World Hypertension League’s 2017 theme of ‘Know your numbers’ calls attention to awareness and prevention, those treating and managing hypertension may give thought at this time to the long-term impact of the disease and its treatment. 1
According to the World Health Organisation, a third of South African adults have hypertension, with the consequent increase in the risk of heart attack, heart failure, kidney disease or stroke. 2 Mortality reduction should be the ultimate goal of antihypertensive treatment. 3
ACE inhibitors (AECIs) are one of the first line treatment options for uncomplicated primary hypertension.4 Despite their positive impact on mortality reduction, ACEIs have been shown to reduce the levels of vitamin D3 in the body. 5 Most South Africans are already compromised in terms of vitamin D3 levels, despite living in a sunny country. 6
Long-term use of ACEIs also results in the depletion of zinc, which may complicate the clinical features of atherosclerosis, amongst other effects.7 Diseases such as diabetes, heart failure and hypertension might also enhance zinc deficiency. 8
Vitamin D and zinc play a role in the Renin Angiotensin System (RAS) system which regulates blood pressure. Inappropriate stimulation of RAS has been associated with the pathogenesis of hypertension, heart attack, stroke and hypertrophy of the left ventricle and vascular smooth muscle cells.9 This may increase risk of death from stroke, coronary heart disease and heart failure. 10, 11
Awareness of the potential depletion of these nutrients, as a result of hypertension, or the treatment thereof, leads to the question of how to best handle this problem. Exposure to sunlight and food sources such as oily fish, offer an option for the replacement of vitamin D3, while oysters, red meat and poultry offer supplementation sources for zinc. 11,12
A relatively new range of supplements marketed by the OTC division of Adcock Ingram includes a presentation especially formulated for use in patients who are on antihypertensive treatment. ACEI-GAP assists in the maintenance of the essential nutrients that may be depleted as a result of hypertension and the treatment thereof. Containing vitamin D3 and zinc, ACEI-GAP is an adjunct to antihypertensive therapy with ACEIs, and hence the name ACEI-GAP.9
The vitamin D3 and zinc contained in ACEI-GAP, are the essential nutrients that may be depleted as a result of hypertension and the treatment thereof with ACEIs. ACEI-GAP is formulated to offer a convenient once daily dosage and each capsule contains 800 international units of vitamin D3 and 15 milligrams of zinc. 9
All the products in the GAP range are supported by clinical data and have been formulated to offer a convenient single daily dosage.
Further information on the GAP range is available at: www.adcockgap.co.za
AECI-GAP: Each capsule contains vitamin D3 800 IU; zinc 15mg.
For full prescribing information refer to the package insert.
- World Hypertension League. World Hypertension Day. [cited 2018 May 04]; Available from: http://www.whleague.org/index.php/features/world-hypertension-day
- Lloyd-Sherlock P, Beard J, Minicuci N, et al. Hypertension among older adults in low and middle-income countries: prevalence, awareness and control. Int J Epidemiol 2014;43:116-128.
- Ferrari R, Boersma E. The impact of ACE inhibition on all-cause and cardiovascular mortality in contemporary hypertension trials: a review. Expert Rev CardiovascTher 2013; 11(6):705-717.
- Seedat YK,Rayner BL, Veriava Y, South African hypertension practice guideline 2014. Cardiovasc J Afr 2014;25(6):288-294
- Sohl E, van Schoor NM, de Jongh RT, et al. The impact of medication on vitamin D status in older individuals. Eur J Endocrinol 2012;166:477-485
- Mchiza ZJ, Steyn NP, Hill J, et al. A review of dietary surveys in the adult South African population from 2000 to 2015. Nutrients 2015;7:8227-825.
- Braun LA, Rosenfeld F. Pharmaco-nutrient interactions – a systemic review of zinc and antihypertensive therapy. Int J Cain Pract 2013;67(8):717-725.
- Cohen N, Golik A. Zinc balance and medications commonly used in the management of heart failure. Heart Fail Rev 2006;11:19-24
- ACEI-GAP approved package insert
- Chun Li Y, Qiao G, Uskokovic M, et al. Vitamin D: a negative endocrine regulator of the renin-angiotensin system and blood pressure. J Steroid Biochem Molec Biol 2004;89-90:387-392
- Ferder M, Inserra F, Manucha W. The world pandemic of vitamin D deficiency could possibly be explained by cellular inflammatory response activity induced by the renin-angiotensin system. Am J Physiol Cell Physiol 2013;304:C1027-C1039.
- Zinc – health professional fact sheet. NIH Office of Dietary Supplements, 2016 ([cited 2018 May 04]; Available from: https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/
- Eat for life: The Food and Nutrition Board’s Guide to Reducing Your Risk of Chronic Disease. [cited 2018 May 04]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK235010/.
About the GAP range:
The Adcock Ingram Over the Counter (OTC) division launched a comprehensive range of 10 health supplements during 2017, each specifically formulated to assist in the maintenance of the essential nutrients that may be depleted as a result of chronic (long-term) diseases and the treatment thereof.
Vitamins and minerals are a diverse group of substances that play an important role in patient well-being. Compared to proteins, carbohydrates and fats, the body needs very small amounts of these nutrients to function efficiently.13
About the Adcock Ingram OTC division:
The OTC division competes in the self-medication pharmacy and FMCG sectors of the market, with a complement of 88 premium and economy brands. Well-known brands include Citro-Soda, Corenza Para-C and Allergex Non-Drowsy. The portfolio includes pain, cough and cold, allergy, digestive well-being medication and energy supplements.