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Aims of treatment of hypertension
1Department of Medicine, Ostra Hospital, Göteborg, Sweden.
Insights
Lowering blood pressure (BP) to normotensive levels is crucial for reducing cardiovascular risks in hypertension. Even treated patients face risks due to inadequate BP control, highlighting the need for better management and potential interventions like beta-blockers for coronary heart disease prevention.
Area of Science:
- Cardiology
- Hypertension Research
- Pharmacology
Background:
- Arterial hypertension significantly increases risks of cardiovascular and cerebrovascular morbidity and mortality.
- Risk is directly correlated with blood pressure (BP) levels, even within the typically considered normotensive range.
- Inadequate BP control in treated hypertensive patients persists as a major issue, leading to elevated risks compared to normotensive individuals.
Purpose of the Study:
- To emphasize the critical need for achieving strictly normotensive blood pressure (BP) levels in the treatment of arterial hypertension.
- To address the persistent morbidity and mortality risks in treated hypertensive patients, particularly those related to coronary heart disease (CHD).
- To explore the potential role of beta-blockers as a direct measure for primary prevention of CHD in hypertensive patients.
Main Methods:
- Review of large-scale clinical trials, including the Medical Research Council (MRC) and International Prospective Primary Prevention Study in Hypertension (IPPPSH).
- Analysis of the relationship between achieved BP levels during treatment and patient outcomes.
- Evaluation of the evidence supporting the use of beta-blockers for primary prevention of CHD in hypertensive populations.
Main Results:
- Elevated BP levels, even in treated patients, are linked to increased risks of cardiovascular events.
- Inadequate BP control remains a primary reason for the continued high morbidity and mortality rates in hypertensive individuals.
- While large studies showed limited primary preventive effects of beta-blockers against CHD in specific groups, their potential role remains a logical consideration.
Conclusions:
- Strictly achieving normotensive blood pressure (BP) levels is essential for mitigating cardiovascular risks associated with arterial hypertension.
- Improved BP control and targeted interventions, such as the use of beta-blockers, are necessary to further reduce coronary heart disease (CHD) risks in hypertensive patients.
- Further investigation into the primary preventive effects of beta-blockers against CHD in hypertension is warranted.
Abstract:
The major aim of treatment of arterial hypertension is to reduce the increased risks of cardio-cerebrovascular morbidity and mortality that are associated with elevated blood pressure (BP). A direct relationship can be found between the level of BP and risk, even down to what is normally considered to be the "normotensive range", i.e., diastolic BPs of 80 mm Hg. Moreover, when considering that the risk in treated hypertensive patients is more closely linked to the BP level achieved during treatment than to the initial untreated level, it becomes obvious that the aim should be to lower elevated arterial pressure to strictly "normotensive" levels. Recently, the results of several large-scale trials have shown that treated hypertensive patients still have an increased risk for morbidity and mortality, compared with normotensive subjects recruited from the same population and of the same sex and age. The main reason for this appears to be inadequate control of BP. Since mortality and morbidity from coronary heart disease (CHD) still constitute the major risk in hypertension, special efforts should be directed towards this problem. In addition to the obvious need for better control of BP, there appears to be a need also for direct measures against CHD. The beta-blockers are therefore of particular interest. Despite the fact that the large-scale Medical Research Council (MRC) and the International Prospective Primary Prevention Study in Hypertension (IPPPSH) studies only indicated that beta-blockers could have a primary preventive effect against CHD in nonsmoking male patients, the possibility that beta-blockers may in fact have a primary preventive effect against CHD in hypertension is still logical.