According to a WHO survey, high blood pressure is not only the most important cardiovascular risk factor involving ~25–30% of the general population, it is also a major cause of death globally, and is anticipated to dramatically increase mortality in developing countries in the near future.
The first aim of hypertensive management is blood pressure (BP) normalization. Since guidelines substantially agree with aggressive targets (<130–80 mmHg), combination therapy is now the first step in antihypertensive treatment. However, BP normalization per se reduces but does not normalize the incidence of hypertension-related diseases, including stroke, coronary artery disease, heart failure and renal failure. To improve treatment effectiveness, the pathophysiological promoters of cardiovascular disease (including overactivity of the sympathetic nervous system) should be considered. Consequently, in many cases, high sympathetic activity (which is easily assessed by measuring heart rate) should be a major determinant of the choice of antihypertensive drugs.
Hypertension is responsible for many major health complications, including coronary artery disease and heart failure. Coronary artery disease requires careful patient evaluation and appropriate treatment. Guidelines can help the clinician care for these patients, but it is essential that signs and symptoms are carefully monitored and followed in individual patients to achieve an optimum outcome. Ultimately, heart failure is the final complication of hypertension and a poignant demonstration that preventive treatment has failed. It is important to discuss the mechanisms involved in the transition from hypertension to heart failure, and where intervention and treatment strategies can be effective in preventing this end-stage disease.
Hypertension treatment remains a challenging issue that requires an ongoing focus in medical education programs, and continuing promotion of adherence to the latest recommendations from international guidelines.
