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Current and future strategies in the treatment of hypertension
1Department of Medicine, University of Gothenburg, Ostra Hospital, Sweden.
Insights
Lowering blood pressure in hypertensive patients is crucial, but current treatments may not fully reduce cardiovascular risk. New strategies are needed to achieve normotensive levels and address drug-related side effects.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Arterial hypertension treatment aims to reduce cardiovascular morbidity and mortality.
- Despite treatment, hypertensive patients face elevated cardiovascular risks compared to normotensive individuals.
- Current antihypertensive therapies may have limitations, including insufficient blood pressure reduction or adverse effects.
Purpose of the Study:
- To investigate the reasons for persistent cardiovascular risk in treated hypertensive patients.
- To evaluate the impact of antihypertensive drugs on hypertension-induced structural cardiovascular changes.
- To propose strategies for optimizing antihypertensive treatment to improve patient outcomes.
Main Methods:
- Review of large-scale intervention trials on blood pressure lowering.
- Analysis of potential explanations for residual cardiovascular risk in treated hypertensive patients.
- Assessment of the effects of current antihypertensive drug regimens on structural cardiovascular changes.
Main Results:
- Treated hypertensive patients exhibit higher cardiovascular morbidity and mortality than untreated normotensive subjects.
- Incomplete blood pressure normalization and drug-induced side effects may contribute to residual risk.
- Many current antihypertensive drugs do not reverse hypertension-induced structural cardiovascular changes.
Conclusions:
- Further efforts are needed to achieve strictly normotensive blood pressure levels in hypertensive patients.
- Antihypertensive drugs with positive effects on structural cardiovascular changes are desirable.
- Optimizing treatment strategies may reduce the excess cardiovascular risk in treated hypertensive patients.
Abstract:
Treatment of arterial hypertension is an important part of the medical care provided in industrialized countries today. Its rationale comes from large-scale intervention trials which have shown that lowering of elevated blood pressure reduces cardiovascular morbidity and mortality. Nevertheless, during the last few years it has been shown that treated hypertensive patients are still at an increased risk of cardiovascular morbidity and mortality compared with untreated normotensive subjects of the same age and sex. Possible explanations for this disappointing finding are that blood pressure has not been lowered to strictly normotensive levels; that some elements of the excess morbidity and mortality are not prevented by antihypertensive therapy, e.g., the part attributable to coronary artery disease; or that the drugs used may themselves have negative effects, e.g., on serum lipids, which may offset the positive effects of lowered blood pressure. It is desirable that antihypertensive treatment produces a reversal of hypertension-induced structural cardiovascular changes such as left ventricular hypertrophy or increased wall/lumen ratio in the precapillary blood vessels, but many of the current antihypertensive drug regimens have no effect on structural cardiovascular changes. Against this background it would appear logical to make renewed efforts to reduce blood pressure into the clearly normotensive range in an attempt to lower the excess risk demonstrable in treated hypertensive patients. It would also seem logical to use antihypertensive drugs that could also be expected to have positive effects on hypertension-induced structural cardiovascular changes.(ABSTRACT TRUNCATED AT 250 WORDS)