Clinical Management of Coronary Heart Disease in Hypertension
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GUIDELINES
Clinical Management of Coronary Heart Disease in Hypertension Practical recommendations from the Italian Society of Hypertension (SIIA) Massimo Volpe • Bruno Trimarco • Allegra Battistoni Giuseppe Mancia
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Received: 8 July 2013 / Accepted: 10 July 2013 / Published online: 13 August 2013 Ó Springer International Publishing Switzerland 2013
Keywords High blood pressure Coronary artery disease Global cardiovascular risk Cardiovascular risk stratification
1 Introduction Hypertension is a major modifiable risk factor, which significantly and independently increases the risk of developing major cardiovascular (CV) complications, mostly myocardial infarction. On the other hand, an effective treatment of hypertension substantially reduces the risk of developing such complications. However, the control of blood pressure (BP) remains largely unsatisfactory in most Western countries, including Italy. Recent analysis of data collected at the European level on BP control rate have demonstrated, in fact, that only 20–30 % of treated hypertensive patients achieve the recommended BP goals [1–4]. For example, in our Country, M. Volpe (&) A. Battistoni Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome ‘‘Sapienza’’, Sant’Andrea Hospital, Via di Grottarossa 1035-39, 00189 Rome, Italy e-mail: [email protected] M. Volpe IRCCS Neuromed, Pozzili, Isernia, Italy B. Trimarco Department of Clinical Medicine, Cardiovascular Sciences and Immunology, Federico II University, Naples, Italy G. Mancia Department of Clinical Medicine, Milano Bicocca University, Milan, Italy
results from observational studies conducted between 1995 and 2005 demonstrated that in more than 52,000 of treated hypertensive patients, about 39 % had grade 1 hypertension (140–159/90–99 mmHg) and about 32 % had grade 2 hypertension (160–179/100–109 mmHg) [5]. A recent update of this analysis, which took into account studies conducted in Italy from 2005 to 2011 and included approximately 160,000 patients with hypertension mainly followed in the context of General Practitioners, reported that only 57 % of patients with hypertension were adequately treated, among which only 37 % achieve effective BP control under treatment [6]. These results confirm that BP control amongst the hypertensive population is still largely unsatisfactory in Italy. Since hypertension is an ideal identifiable target to reduce global cardiovascular risk, it is clear that effective strategies, aimed at improving high BP control in the general population of hypertensive patients, represent a fundamental step of any preventive strategy in our Country, as well as in Western and Developing Countries, with subsequent beneficial effects for the National Health System. Based on these considerations, the Italian Society of Hypertension (SIIA) aims to generate, circulate and share a number of interventions to improve BP control in Italy. Among the various initiatives, which include integrated and concerted ac
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