Preventing the cardiovascular complications of hypertension

Abstract

Hypertension has reached pandemic proportions. Merely controlling the numbers of systolic & diastolic blood pressure is no longer the goal. Reducing the overall risk of the individual for cardiovascular events, preventing target organ dysfunction, yet maintaining quality of life & minimizing medication is aimed at. Multiple high power trials, JNC VII & European guidelines for management of hypertension indicate clearly that tighter control of blood pressure, choosing medications which improve endothelial dysfunction are means of achieving these goals. Conventional management of hypertension leaves patients with an unacceptably high risk of CV events due to failure to address coexisting risk factors. Lifestyle modifications in the form of DASH diet, weight reduction, aerobic activity, moderation in alcohol consumption form the basis of tight BP control in any stage of hypertension. Multiple medications in small dose combinations need to be applied as first line therapy. Thiazide like diuretic including Indepamide featuring in all combinations is second principle. ACE inhibitors especially Ramipril & Perindopril in appropriate dosages have important role to play. Regression of LV hypertrophy is documented with prolonged use of ACEI. Statins should be used liberally in hypertensive individuals even with marginally high lipids or with associated diabetes mellitus. Use of long acting Nifedipine/Amlodepin has surfaced again for their endothelial dysfunction improvement properties and probable anti-atherosclerotic effect. Quinapril as ACEI has evidence for improvement of endothelial dysfunction. The hypothetical “polypill” is likely to emerge for hypertension management especially for prevention of complications. In special subgroups like diabetics, chronic kidney disease, coronary artery disease, maintaining blood pressure of 120/80mm of Hg & below is clearly shown to be beneficial to prevent cardiovascular & global risk. Lifestyle modification, multiple small dose preventive drug combinations, tighter control of BP & biochemical parameters are the cornerstones of preventing CV complications of hypertension. Periodic checks for early detection and management of CV complications and health insurance for all, are additional points to note.