Benefits Beyond Hypertension Control: Current and Evolving Treatment Strategies for Prevention of Cardiovascular...

Cardiovascular Disease (CVD) continuum often begins with uncontrolled hypertension, progressing through structural/functional impairment of the cardiovascular system and atherosclerosis toward myocardial infarction, stroke, and cardiovascular death. Hypertension affects over one billion people globally, yet less than half have been diagnosed and received treatment. Suboptimal management of elevated Blood Pressure (BP) remains a challenge across low- and middle-income countries, including India. This review outlined the CVD continuum associated with hypertension, along with guideline-recommended new paradigm and emerging/ novel approaches for managing hypertension and CVD risk.

Data from PubMed and Google Scholar have been extracted using the following search terms: cardiovascular disease continuum, hypertension management, cardiovascular risk reduction, anti-hypertensive drugs, non-pharmacological approach, guideline recommendations, evolving strategies, and herbal medicine.

A total of 101 articles, published between 2004 and 2025, were included, comprising 20 systematic reviews and meta-analyses, 27 trials, 24 research articles, 10 guidelines, 18 review articles, and 2 editorials. The evidence and guideline recommendations on clinical and therapeutic considerations for effective management of hypertension have been discussed.

Several guidelines preferred initial treatment (BP threshold: 130-140/80-90 mmHg) with monotherapy (angiotensin-converting enzyme inhibitor/ angiotensin-receptor blocker/ calcium channel blocker/ diuretic/ beta-blocker) or combination therapy of two or more medications with complementary mechanisms (in a single-pill) for managing cardiovascular complications and improving treatment adherence. Beta-blockers are thought to be recommended for people with cardiovascular complications, but their effect in reducing stroke, infarction, and mortality is inferior to other drug classes. The addition of an anti-aldosterone drug to the first-line therapy is recommended for managing resistant hypertension. Recent pharmacological advancements, including anti- aldosterone agents, non-steroidal mineralocorticoid receptor antagonists, endothelin receptor antagonists, etc., have demonstrated remarkable efficacy in BP reduction with tolerable safety profiles.

A holistic management strategy integrating standard medical care along with lifestyle modifications, herbal medicines, and digital health platforms could enhance treatment adherence and interrupt the CVD continuum.