Related Experiment Videos
[Treatment of hypertension and cardiovascular complications]
J P Delahaye1, M Pillot, F Delahaye
1Hôpital cardiovasculaire et pneumologique, BP Lyon-Montchat.
Insights
Personalized hypertension management, integrating physiopathological, epidemiological, and pharmacological approaches, aims to prevent cardiovascular complications. Modern antihypertensive therapies effectively reduce risks like malignant hypertension and cardiac failure.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Epidemiology
Context:
- Hypertension management involves multiple approaches.
- Cardiovascular complications of hypertension include left ventricular hypertrophy and malignant hypertension.
- Modern antihypertensive therapies have significantly reduced complications.
Purpose:
- To converge physiopathological, epidemiological, and pharmacological approaches for personalized hypertension management.
- To outline the role of specific antihypertensive agents in managing hypertension-related cardiovascular complications.
- To emphasize the importance of risk stratification and patient history in treatment selection.
Summary:
- Certain antihypertensive agents may correct hypertensive left ventricular hypertrophy, though benefits require further proof.
- Malignant hypertension and its complications are largely managed by modern therapies.
- Lowering diastolic pressure by 8-10 mmHg halves cerebrovascular risk and reduces coronary risk by a quarter.
- Diuretic and beta-blocker therapies remain reference treatments for hypertension complications.
- Personalized therapy considers risk degree and prior complications, favoring beta-blockers with calcium antagonists for coronary artery disease/arrhythmias, and ACE inhibitors for severe hypertension or cardiac failure.
Impact:
- Effective prevention and cure of hypertension-related cardiac failure.
- Significant reduction in cardiovascular mortality (20%) and total mortality.
- Reduced cerebrovascular and coronary risks through blood pressure control.
- Established reference drug classes (diuretics, beta-blockers) for hypertension management.
Abstract:
The three approaches (physiopathological, epidemiological and pharmacological) to the management of hypertension should converge to provide a personalized prescription of the most appropriate treatment to prevent and/or cure the cardiovascular complications of hypertension: hypertensive left ventricular hypertrophy and the risks directly related to it (haemodynamic, arrhythmic, ischaemic) may be corrected by certain antihypertensive agents (methyldopa, ACE inhibitors, some calcium antagonists) although there is no proof as yet of the benefits of this intervention (which could suppress the adaptation to the increased wall stress of the left ventricle); malignant hypertension and its cardiovascular complications have almost disappeared with modern antihypertensive therapy. Cardiac failure can be effectively prevented and cured when exclusively related to hypertension. When diastolic pressures are lowered by 8-10 mmHg cerebrovascular risk is reduced by a half and coronary risk by a quarter. Cardiovascular mortality related to hypertension is thus reduced by 20% and total mortality is thereby significantly decreased; the large scale clinical trials which provided these data were performed in the years 1965-1985 with diuretic therapy relayed by (or compared with) betablockers from 1980 onwards. These two families remain the drugs of reference in the prevention and treatment of the cardiovascular complications of hypertension. Personalized description of antihypertensive therapy should take into account the degree of risk and previous cardiovascular complications of the hypertensive patient: betablockers eventually associated with calcium antagonists are to be preferred in cases of hypertension with coronary artery disease and/or arrhythmias, severe hypertension and hypertension complicated by cardiac failure are good indications for ACE inhibitors without prejudicing other therapeutic options necessary in certain contexts, in particular aspirin therapy in patients with previous transient ischemic cerebral attacks.(ABSTRACT TRUNCATED AT 250 WORDS)