Keywords
1. Chronic Rhinosinusitis
2. Nasal Polyps Treatment
3. Antihypertensive Therapy
4. Quality of Life Improvement
5. Periostin Reduction
In a remarkable study published in the esteemed ‘Acta Otorrinolaringologica Española’, researchers have illuminated the pathway to improved living for individuals plagued by chronic rhinosinusitis with nasal polyps (CRSwNP). The study, led by Juan J. Maza-Solano and his dedicated team at the Hospital Universitario Virgen de la Macarena in Sevilla, Spain, suggests that antihypertensive medications could play a pivotal role in bolstering the quality of life for these patients.
The comprehensive retrospective study (DOI: 10.1016/j.otoeng.2024.01.003), delineated the experiences of 43 patients who exhibited CRSwNP alongside arterial hypertension, with a minimum follow-up period of one year post-diagnosis and subsequent antihypertensive treatment. The patients’ phenotypes were divided into two categories: F1 (isolated CRSwNP) and F2 (CRSwNP concurrent with asthma and/or non-steroidal anti-inflammatory drug-exacerbated respiratory disease (NERD)) for detailed analysis.
Key findings from the investigation revealed a significant decrease in exacerbations post-treatment, with the F1 phenotype exhibiting a 19.2% reduction in contrast to the 31.3% within the F2 group. Moreover, 34.8% of the participants necessitated surgery post-antihypertensive treatment initiation, with a lower surgery rate noted in the F1 phenotype at 27.9% versus 6.97% for F2.
The most striking outcomes were reflected in the measured variables related to quality of life, specifically the Sino-Nasal Outcome Test-22 (SNOT-22) and Visual Analogue Scale (VAS), as well as the reduced polypoid size. There was a substantial reduction in SNOT-22 scores (16.4 ± 19.6 points) and VAS, alongside a marked decrease in polyp size—all indicators of enhanced patient welfare post-treatment, with statistical significance denoted by p-values less than 0.05.
The novel connection between antihypertensive treatment and CRSwNP draws from the shared inflammatory pathways with other conditions such as asthma, allergy, and notably, arterial hypertension. A key inflammation biomarker linking these disorders is periostin, noted for its potential to predict the severity and likelihood of polyp recurrence following surgery. Prior research underscores the potential of antihypertensives to mitigate periostin expression, hence, the crux of this study’s hypotheses and consequent results.
The research team extended beyond Maza-Solano’s group, with Carmen C. Palma-Martínez, Daniel D. Martín-Jiménez, Serafín S. Sánchez-Gómez, Ramón R. Moreno-Luna, Christian C. Calvo-Henriquez, and Hugo H. Galera-Ruiz contributing their expertise to this groundbreaking work. The collective effort consolidated findings that are anticipated to reshape treatment protocols for CRSwNP sufferers globally.
While the study presents compelling evidence for the beneficial impact of antihypertensive medications on individuals grappling with CRSwNP, it is crucial that future research explores these observations further. Randomized controlled trials on larger patient cohorts would be instrumental in corroborating the efficacy and outlining robust treatment frameworks.
References
1. Maza-Solano, J. J., Palma-Martínez, C. C., Martín-Jiménez, D. D., Sánchez-Gómez, S. S., Moreno-Luna, R. R., Calvo-Henriquez, C. C., & Galera-Ruiz, H. H. (2024). Effect of antihypertensive treatment on the quality of life of patients with chronic rhinosinusitis with nasal polyps. Acta Otorrinolaringologica Española, S2173-5735(24)00005-X. DOI: 10.1016/j.otoeng.2024.01.003.
2. Hopkins, C., Gillett, S., Slack, R., Lund, V. J., & Browne, J. P. (2009). Psychometric validity of the 22-item Sinonasal Outcome Test. Clinical Otolaryngology, 34(5), 447-454. DOI: 10.1111/j.1749-4486.2009.01995.x.
3. Bachert, C., Zhang, N., Hellings, P. W., & Bousquet, J. (2020). Endotypes of chronic rhinosinusitis: Impact on management. Journal of Allergy and Clinical Immunology, 145(3), 752-756. DOI: 10.1016/j.jaci.2019.12.911.
4. Sidhu, V. S., Orchard, D. C., & Barton, R. P. (2019). Periostin and its role in chronic rhinosinusitis. American Journal of Rhinology & Allergy, 33(6), 569-576. DOI: 10.1177/1945892419855626.
5. Kountakis, S. E., Arango, P., & Bradley, D. (2004). Molecular and cellular staging for the severity of chronic rhinosinusitis. Laryngoscope, 114(11), 1895-1905. DOI: 10.1097/01.mlg.0000147923.48814.25.
This pioneering research by Maza-Solano and colleagues unfailingly contributes an advanced perspective to the medical field’s understanding of CRSwNP and related comorbidities, potentially heralding a new era in patient care and therapeutic approaches. As with all medical advancements, patient care is central, and this study undeniably propels healthcare professionals closer toward more personalized and effective treatment regimens for CRSwNP patients struggling with the daily impacts of their condition.
