Treatment of Hypertension
- PDF / 67,444 Bytes
- 3 Pages / 612 x 791 pts Page_size
- 41 Downloads / 167 Views
High Blood Press Cardiovasc Prev 2003; 10 (1): 7-9 1120-9879/03/0001-0007/$30.00/0 © Itlalian Society of Hypertension 2003. All rights reserved.
Treatment of Hypertension Is the Gap between Objectives and Outcomes Insurmountable? Massimo Volpe1,2 1 Division of Cardiology, Second Faculty of Medicine, Sant’Andrea Hospital, University of Rome “La Sapienza”, Rome, Italy 2 IRCCS Neuromed, Pozzilli (IS), Italy
Recently, a number of studies have highlighted the difficulty in achieving sufficient control of morbidity and mortality associated with high blood pressure in patients with hypertension. Most of the studies completed in the last few years, including the ‘monster’ ALLHAT trial,[1] have shown that only a limited number of patients with hypertension are successfully treated with the current therapies, i.e. that the patients absolute risk of a cardiovascular event and/or mortality is reduced to a similar level as that of the general population, whereas a much higher number of patients, despite the achievement of satisfactory levels of blood pressure, remain at high risk. Interventional comparative studies, including the recent LIFE trial,[2] have shown that it may be possible to better control morbidity, i.e. cerebrovascular morbidity and cardiovascular outcomes, in high-risk hypertensive patients by using drugs which appear to provide further benefit and protection beyond the control of blood pressure. This interpretation of the results from large controlled, randomised, trials in hypertension raises again the issue of whether, and how, antihypertensive treatments can provide almost complete protection, or at least additional protection, beyond the control of blood pressure levels. The current treatment of hypertension (based on the use of the most recently available drugs), may provide greater benefits than in the past, be better tolerated, more effectively reduce blood pressure levels, have fewer drugdrug interactions, and tend to effectively limit the further development of intermediate endpoints, such as left ventricular hypertrophy, retinal damage, carotid artery lesions or atherosclerosis, and microalbuminuria or proteinuria. However, the goal of therapy should be the total prevention of cardiovascular disease in hypertensive patients; in contrast, reality shows that no matter which innovative therapy is used, the level of protection is, on average, the ‘mythical’ 30% risk reduction which is gained by using aggressive and multi-drug treatment regimens. Recently presented data from the ASCOTT trial[3] and the Gaede et al.[4]
study suggest that the intensive treatment of cardiovascular risk factors beyond blood pressure control with statins or other treatments limiting cardiovascular risk, such as aspirin in the HOT study,[5] may be beneficial in hypertensive patients. In fact, cardiovascular risk in patients with hypertension remains a major problem worldwide. The most recent epidemiological data published by the WHO and the American Heart Association confirmed that cardiovascular disease remains the largest
Data Loading...
