[Clinical approach to the hypertensive patient. New guidelines]

Prospective observational studies clearly show that the risks of stroke, coronary artery disease, and premature death are directly related to blood pressure levels. Yet as the results of prospective randomized intervention studies have indicated, these risks are reduced by effective blood pressure control. Over a 5-year period, an average reduction of 5-6 mmHg in diastolic blood pressure and of 10-12 mmHg in systolic blood pressure is associated with a 38% decrease in risk of stroke and a 16% decrease in risk of coronary heart disease. Although awareness of hypertension has increased markedly, and the number of patients treated for this condition has approximately doubled over the last 20 years, premature morbidity and mortality remain higher than in the normotensive population. This situation may arise from the inadequate level of blood pressure control achieved in many patients. Thus, although delineating theoretical rules to treat hypertension seems relatively easy, in real life it is not always possible to adhere to them. This difficulty highlights the need for appropriate guidelines in clinical practice. A number of national groups as well as the World Health Organization and the International Society of Hypertension have recently published recommendations for the diagnosis and treatment of hypertension. Physicians must strive to improve the management of hypertension and remember that a thorough clinical evaluation, treatment of associated cardiovascular risk factors, prevention of target organ damage, and good patient compliance are key elements affecting the success of therapy.