[Arterial hypertension 2007: Guidelines for the management of arterial hypertension]

Since the publication of "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" (JNC 7) in 2003 and "2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension" (ESH/ESC guidelines), no substantial improvement has been made in the control of hypertension. Maybe, publishing of new 2007 Guidelines for the Management of Arterial Hypertension will contribute to a more rational and purposeful management of hypertension. The question whether beta blockers will keep their place as the first-line therapy in the new guidelines has been opened. After 30 years of their use in clinical practice, beta blockers have again become the focus of great discussion and controversy. Namely, according to the National Institute for Health and Clinical Excellence (NICE), beta blockers, which were for more than 30 years the first-line therapy for the treatment of high blood pressure, and antihypertensive effects of which were well documented in large randomized placebo controlled studies, have lost the first-line therapy role. Yet the normalization of the blood pressure has been difficult in spite of using the nowadays available drugs. This makes the question of disposal of such drugs even more open and disputable. Taking this into account, the 2007 Guidelines for the Management of Arterial Hypertension have kept beta blockers as the first line therapy. Besides, the separate guidelines for treatment of arterial hypertension and hypercholesterolemia, have been replaced by the new guidelines for management of the integrated cardiovascular risk. According to the Guidelines, the cardiovascular risk score should be applied in the everyday practice. Since cardiovascular risk factors multiply and interact with each other, moderate reduction in several factors will be more beneficial than major reduction in one. Much more than the 2003 ESH/ESC guidelines do, the new 2007 Guidelines emphasize the combined drug therapy using smaller dosages for simultaneous treatment of several cardiovascular risk factors as a replacement for separate management of hypertension alone. Also, there is a new goal of < 130/80 mm Hg for people with established cardiovascular disease including coronary artery disease, diabetes, renal dysfunction, or proteinuria. However, the main benefits of antihypetensive therapy are due to lowering of blood pressure per se.