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Current challenges in the clinical management of hypertension

Nature Reviews Cardiology volume 9, pages 267–275 (2012)Cite this article

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Abstract

Elevated blood pressure (BP) is probably the most-important modifiable risk factor for cardiovascular disease (CVD). BP influences the development of CVD, even if levels of BP are well below the usual cut-off point that defines the presence of arterial hypertension. Adequate measurement of BP is the most-important requirement for the diagnosis and treatment of patients with suspected hypertension. The use of methodologies such as ambulatory and home BP monitoring have become powerful tools for defining the 'real' BP of patients, discarding the white-coat effect, and discovering masked hypertension. Early intervention with life-style changes and antihypertensive drugs is required to obtain the best outcome for the patient. In this sense, early use of combination antihypertensive drug therapy is recommended. The treatment of resistant hypertension—the type of elevated BP that is most difficult to control—has clearly improved over the past decade. Further studies are required to define how antihypertensive therapy should be used in the earliest stages of hypertension and for the treatment of patients with a mild-to-moderate increase in global cardiovascular risk.

Key Points

  • Half of the burden of cardiovascular disease (CVD) in the general population is attributable to high blood pressure (BP); the threshold BP for the initiation of antihypertensive treatment is currently 140/90 mmHg

  • CVD and renal disease often develop in parallel in the cardiovascular continuum, and control of BP is required at all stages of this continuum to improve patient outcome

  • A BP goal of <130/80 mmHg could represent a risk for patients with coronary artery disease, but might be considered for patients with proteinuria or those at high risk of stroke

  • The prompt use of combination antihypertensive drug therapy facilitates initial BP control; patient compliance and treatment adherence improve BP control during therapy

  • Resistant hypertension continues to occur frequently, although BP control has improved with the use of aldosterone blockers and techniques such as renal denervation and baroreceptor stimulation

  • New studies, particularly of the early stages of arterial hypertension, are required and a more-frequent use ambulatory and home BP measurements is recommended

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Figure 1: The 'cardiorenal continuum' reflects the different stages of cardiovascular disease and renal disease, which are often interlinked.

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  1. Hypertension Unit, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain

    Luis M. Ruilope

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Ruilope, L. Current challenges in the clinical management of hypertension. Nat Rev Cardiol 9, 267–275 (2012). https://doi.org/10.1038/nrcardio.2011.157

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