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Prevention of cardiovascular disease in hypertensive patients with normal renal function
J T Wright1, J G Douglas, M Rahman
1Department of Medicine, Case Western Reserve University, School of Medicine, University Hospitals of Cleveland, OH 44106-4982, USA. jxw20@po.cwru.edu
Insights
Aggressively treating hypertension is crucial for preventing cardiovascular disease (CVD). Lowering blood pressure (BP) to below 140/90 mm Hg, using lifestyle changes and medication, is key for most patients.
Area of Science:
- Cardiology
- Nephrology
- Public Health
Background:
- Hypertension is a significant risk factor for cardiovascular disease (CVD).
- Global consensus panels recommend aggressive hypertension management based on extensive data.
- Recommendations for preventing CVD in renal disease patients are informed by hypertension data.
Purpose of the Study:
- To outline evidence-based recommendations for hypertension management.
- To emphasize the importance of blood pressure control for CVD prevention.
- To guide the selection of antihypertensive agents based on clinical outcomes.
Main Methods:
- Review of over two decades of clinical trial data.
- Analysis of long-term epidemiologic data on hypertension.
- Synthesis of recommendations from worldwide consensus panels.
Main Results:
- Most patients require blood pressure (BP) reduction to <140/90 mm Hg.
- High-risk patients, including those with diabetes or target organ damage, need earlier, aggressive intervention.
- Lifestyle modifications are essential for all hypertensive patients.
Conclusions:
- Achieving BP control (<140/90 mm Hg) remains the primary goal in hypertension management.
- Specific antihypertensive agents are supported by outcome data for certain patient groups.
- Despite guidelines, only 25% of hypertensive patients achieve target BP control.
Abstract:
Hypertension is an important risk factor for cardiovascular disease (CVD) in patients with normal renal function. After reviewing over two decades of clinical trial data and an even longer history of epidemiologic data, multiple consensus panels worldwide have made recommendations for the aggressive treatment of hypertension using both lifestyle modification and drug therapy. These data and recommendations provide the basis of the recommendations for preventing CVD in patients with renal disease. Most patients should have elevated blood pressure (BP) lowered to less than 140 mm Hg systolic and less than 90 mm Hg diastolic. Earlier and more aggressive intervention is recommended in high-risk hypertensive patients with risk factors (especially diabetes mellitus) or evidence of target organ damage or clinical CVD. Lifestyle changes are indicated as either initial therapy or concomitant therapy in all hypertensive patients to lower BP and to normalize other CVD risk factors. There is general agreement that clinical outcome data from controlled clinical trials should guide the selection of antihypertensive agents. Currently, these data are only available for thiazide diuretics and beta-blockers for most hypertensive patients with normal renal function and for the dihydropyridine calcium channel blockers in older hypertensive patients with isolated systolic hypertension. However, data may support the use of other agents in hypertensives with selected comorbidity (eg, ACE inhibitors in heart failure, beta-blockers after myocardial infarction, and so forth). However, with only 25% of hypertensive patients controlled to less than 140/90 mm Hg, achieving blood pressure control remains the most important goal in managing hypertension in this population.