High blood pressure, or hypertension, affects nearly 1.3 billion people worldwide. Despite various treatments available, around half of these individuals experience uncontrolled or resistant hypertension, putting them at a higher risk for heart attack, stroke, kidney disease, and early death. A new Phase III clinical trial has made a significant breakthrough in addressing this issue.

The study, led by Professor Bryan Williams from the UCL Institute of Cardiovascular Science, involved nearly 800 patients across 214 clinics worldwide. The participants were given either baxdrostat (1 mg or 2 mg once daily) or a placebo. After 12 weeks, the results showed that those taking baxdrostat experienced an average reduction in systolic blood pressure by around 9-10 mmHg, compared to the placebo group.

This significant drop in blood pressure has substantial implications for cardiovascular health. “Achieving a nearly 10 mmHg reduction in systolic blood pressure with baxdrostat in the BaxHTN Phase III trial is exciting,” Professor Williams stated. “This level of reduction is linked to substantially lower risk of heart attack, stroke, heart failure, and kidney disease.”

The innovative aspect of this treatment lies in its mechanism of action. Blood pressure is strongly influenced by a hormone called aldosterone, which regulates salt and water balance in the kidneys. Some individuals produce excessive amounts of aldosterone, causing their blood pressure to rise and become difficult to control.

Baxdrostat works by directly addressing this issue, blocking the production of aldosterone. This targeted approach has been shown to be effective in reducing blood pressure and improving cardiovascular health. As Professor Williams noted, “These findings are an important advance in treatment and our understanding of the cause of difficult-to-control blood pressure.”

The impact of this breakthrough could be substantial, with potential benefits for up to half a billion people worldwide, including 10 million people in the UK alone. This new treatment offers hope for more effective management of resistant hypertension and improved cardiovascular health outcomes.

The human body has an incredible ability to heal itself after injury or disease. When cells are damaged, they activate various responses to repair the damage and restore normal function. Researchers at Washington University School of Medicine in St. Louis and the Baylor College of Medicine have discovered a previously unknown cellular purging process that may help injured cells revert to a stem cell-like state more rapidly. This phenomenon, dubbed cathartocytosis, involves cells “vomiting” waste in a rapid and messy way, which can aid in healing but also has potential downsides.

Cathartocytosis is part of an important regenerative injury response called paligenosis, where injured cells shift away from their normal roles and undergo reprogramming to an immature state. In this process, mature cellular machinery gets in the way of healing, so a quick way of getting rid of that machinery becomes necessary. This cellular cleanse adds a shortcut, helping the cell declutter and focus on regrowing healthy tissues faster than it would be able to if it could only perform a gradual, controlled degradation of waste.

However, this process also comes with potential downsides. The tradeoff is additional waste products that can fuel inflammatory states, making chronic injuries harder to resolve and correlating with increased risk of cancer development. In fact, the festering mess of ejected cellular waste resulting from cathartocytosis may be a way to identify or track cancer.

Researchers suspect that cathartocytosis could play a role in perpetuating injury and inflammation in Helicobacter pylori infections in the gut. H. pylori is a type of bacteria known to infect and damage the stomach, causing ulcers and increasing the risk of stomach cancer. The findings also point to new treatment strategies for stomach cancer and perhaps other GI cancers.

If we have a better understanding of this process, we could develop ways to help encourage the healing response and perhaps, in the context of chronic injury, block the damaged cells undergoing chronic cathartocytosis from contributing to cancer formation.

The Alarming Impact of Routine X-Rays on Arthritis Patients’ Decisions

Osteoarthritis is a leading cause of chronic pain and disability, affecting millions worldwide. While routine x-rays are not recommended for diagnosing knee osteoarthritis, nearly half of new patients visiting a general practitioner in Australia are referred for imaging. This unnecessary use of x-rays not only wastes the health system A$104.7 million each year but also affects how people think about their knee pain and may prompt them to consider potentially unnecessary knee replacement surgery.

Our study reveals that using x-rays to diagnose knee osteoarthritis can lead patients to believe they need knee replacement surgery more than those who receive a clinical diagnosis without x-ray images. In fact, people who received an x-ray-based diagnosis were 36% more likely to think they needed surgery compared to those with a clinical diagnosis.

But what happens when you get osteoarthritis? It arises from joint changes and the joint working hard to repair itself, affecting the entire joint, including bones, cartilage, ligaments, and muscles. Many people experience persistent pain and difficulties with everyday activities like walking and climbing stairs.

While knee replacement surgery is often viewed as inevitable for osteoarthritis, it should only be considered for those with severe symptoms who have already tried appropriate non-surgical treatments. Surgery carries risks of serious adverse events, such as blood clot or infection, and not everyone makes a full recovery.

Most people with knee osteoarthritis can manage it effectively with:

1. Pain relief medication
2. Exercise and physical activity
3. Weight management
4. Assistive devices

Debunking a common misconception, research shows that the extent of structural changes seen in a joint on an x-ray does not reflect the level of pain or disability a person experiences. Some people with minimal joint changes have very bad symptoms, while others with more joint changes have only mild symptoms.

In our study, we found that people who received an x-ray-based diagnosis and were shown their x-ray images had a higher perceived need for knee replacement surgery than those who received a clinical diagnosis without x-ray. They also believed exercise and physical activity could be more harmful to their joint, were more worried about their condition worsening, and were more fearful of movement.

What does this mean for people with osteoarthritis? Our findings show why it’s essential to avoid unnecessary x-rays when diagnosing knee osteoarthritis. By reducing unnecessary x-rays, we can ease patient anxiety, prevent unnecessary concern about joint damage, and reduce demand for costly and potentially unnecessary joint replacement surgery.
In conclusion, while changing clinical practice can be challenging, reducing unnecessary x-rays could help improve patient outcomes and reduce healthcare costs.

So, if you have knee osteoarthritis, know that routine x-rays aren’t needed for diagnosis or to determine the best treatment for you. Getting an x-ray can make you more concerned and more open to surgery. But there are a range of non-surgical options that could reduce pain, improve mobility, and are less invasive.