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Is hypertension treated adequately?
1Department of Medicine, University of Göteborg, Ostra Hospital.
Insights
Despite blood pressure control, treated hypertensive patients face high morbidity and mortality. This suggests irreversible changes or adverse drug effects may persist, impacting long-term cardiovascular health.
Area of Science:
- Cardiology
- Hypertension Research
- Pharmacology
Background:
- Blood pressure levels strongly correlate with morbidity and mortality in hypertensive patients.
- Antihypertensive treatment demonstrates a relationship between treated blood pressure and patient prognosis.
- Recent studies reveal elevated morbidity and mortality in treated hypertensive individuals compared to normotensive populations.
Purpose of the Study:
- To investigate the reasons behind persistent high morbidity and mortality in treated hypertensive patients.
- To explore potential explanations for suboptimal outcomes despite blood pressure management.
Main Methods:
- Analysis of findings from three large-scale studies on treated hypertensive patients.
- Review of potential contributing factors including irreversible cardiovascular changes, adverse drug effects, and suboptimal blood pressure control.
Main Results:
- Treated hypertensive patients exhibit higher than expected morbidity and mortality rates.
- Long-standing hypertension may lead to irreversible cardiovascular damage.
- Pharmacological treatments might have adverse effects (e.g., on lipids, electrolytes) counteracting benefits.
- Consistent blood pressure reduction is achieved in only a fraction of treated patients.
Conclusions:
- Persistent cardiovascular risks in treated hypertensive patients warrant further investigation.
- Adverse effects of antihypertensive medications and incomplete blood pressure control are potential factors.
- Understanding these factors is crucial for improving long-term outcomes in hypertension management.
Abstract:
In hypertensive patients, morbidity and mortality from the malignant phase, stroke, left ventricular failure, coronary disease and progressive renal failure are closely linked to the level of blood pressure. This relationship between blood pressure and risk can be demonstrated also when blood pressure is lowered with antihypertensive agents. Thus, it appears that the treated blood pressure level is a much stronger indicator of prognosis than is the initial untreated value. However, in the last 2 years, 3 large scale studies have shown that morbidity and mortality in treated hypertensive patients are still considerably higher than expected and significantly greater than in comparable normotensive subjects or control populations. There could be several explanations for these disturbing findings. One is that long-standing hypertension may cause irreversible cardiovascular changes that continue to put such individuals at risk, even after their blood pressure has been brought under control. Another possibility is that the pharmacological agents used in the treatment of hypertension may have some partially adverse effects in addition to their beneficial action on blood pressure. For example, drug-induced changes in serum lipids or of serum electrolytes could somewhat offset the advantages from blood pressure reduction. Furthermore, less than optimal control of elevated blood pressure could be a factor. It is worth noting that consistent arterial pressure reduction has been achieved in only a fraction of treated patients in the large scale intervention trials.(ABSTRACT TRUNCATED AT 250 WORDS)