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:

  1. 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.
  2. Due to ageing, the rising incidence of obesity, and socioeconomic and environmental changes, its incidence is increasing worldwide.
  3. 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.
  4. BP lowering by lifestyle modifications and antihypertensive drugs reduces CV morbidity and mortality.
  5. 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.
  6. 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.
  7. Guidelines recommend dual- and triple-combination therapies using renin–angiotensin system blockers, calcium channel blockers, and/or a diuretic. However, comorbidities often complicate management.
  8. 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.
  9. Catheter-based renal denervation could potentially offer an alternative treatment option in comorbid hypertension associated with increased sympathetic nerve activity.
  10. 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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