Hypertension Management and Cardiovascular Comorbidities
- Lauder L, Mahfoud F, Azizi M, et al.
- Hypertension Management in Patients With Cardiovascular Comorbidities. Eur Heart J 2022;Nov 7:[Epub ahead of print].
The following are key points to remember from a state-of-the-art review on hypertension management in patients with cardiovascular (CV) comorbidities:
- High systolic blood pressure (SBP) is the most prevalent modifiable CV risk factor and a leading cause of death, accounting for 10.8 million deaths globally.
- Due to ageing, the rising incidence of obesity, and socioeconomic and environmental changes, its incidence is increasing worldwide.
- Comorbidities often complicate hypertension because of overlapping pathophysiology and shared risk factors. Hypertension commonly coexists with type 2 diabetes, obesity, dyslipidemia, sedentary lifestyle, and smoking leading to risk amplification.
- BP lowering by lifestyle modifications and antihypertensive drugs reduces CV morbidity and mortality.
- The European Society of Cardiology/European Society of Hypertension hypertension guidelines recommend targeting an office BP <140/90 mm Hg. If tolerated, office SBP should be reduced to 120–129 mm Hg.
- Pharmacotherapy should be initiated swiftly. Only in grade 1 hypertension (office BP 140–159/90–99 mm Hg) at low-to-moderate CV risk, lifestyle interventions without pharmacotherapy can be considered for 3–6 months.
- Guidelines recommend dual- and triple-combination therapies using renin–angiotensin system blockers, calcium channel blockers, and/or a diuretic. However, comorbidities often complicate management.
- New drugs such as angiotensin receptor-neprilysin inhibitors, sodium–glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and nonsteroidal mineralocorticoid receptor antagonists improve CV and renal outcomes.
- Catheter-based renal denervation could potentially offer an alternative treatment option in comorbid hypertension associated with increased sympathetic nerve activity.
- Finally, a therapeutic approach for hypertension management must be individualized according to patients’ comorbidities to optimize clinical outcomes.
Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Heart Failure and Cardiomyopathies, Prevention, Heart Failure and Cardiac Biomarkers, Hypertension, Smoking
Keywords: Aging, Antihypertensive Agents, Blood Pressure, Calcium Channel Blockers, Denervation, Diabetes Mellitus, Type 2, Diuretics, Dyslipidemias, Glucagon-Like Peptide-1 Receptor, Hypertension, Life Style, Mineralocorticoid Receptor Antagonists, Neprilysin, Obesity, Primary Prevention, Receptors, Angiotensin, Renin-Angiotensin System, Risk Factors, Smoking, Socioeconomic Factors, Sodium-Glucose Transporter 2 Inhibitors
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