[High-risk hypertension]

Arterial hypertension is the main risk factor for cardiovascular diseases in western countries and its prevalence, currently around 25% in the general population, is on the rise. Prevention and treatment of high blood pressure and its acute and chronic complications represent a public health priority, due to the relevance of its economic and social consequences. Unfortunately, recent epidemiological surveys indicate that too many patients are either unaware of their condition or are not receiving adequate treatment, in spite of the availability of a large armamentarium of antihypertensive agents which, when used in proper combination, enables the physician to lower blood pressure in virtually all patients. Perhaps more importantly, today it is possible to identify, among the large number of hypertensive patients, those at higher absolute risk for complications. To this end, beside considering the severity of blood pressure load, one should always accurately evaluate the presence of other risk factors and subclinical end-organ damage at the cardiovascular and renal level. This approach is useful in tailoring treatment to each patients' characteristics and leads to the optimisation of its cost/benefit ratio.