Evolution of blood pressure control in Spain

Journal of Hypertension

et al. 2012

Self Cite

Section: Discussionmentioning

confidence: 99%

“…But this improvement is not limited to the last decade. In fact, BP control among treated hypertensive patients in the Spanish primary care setting was 13% in 1995 [18,19]. As BP goals for patients at high risk have changed over this time [11][12][13], a table with different cut points was included ( [24].…”

Section: Discussionmentioning

confidence: 99%

Treatment and blood pressure control in Spain during 2002–2010

Llisterri¹,

Rodríguez-Roca²,

Journal of Hypertension

et al. 2012

Self Cite

“…that is, in Spain it has risen from less than 20% to the current 40% [23]. Notably, BP control has improved among the general population and especially in hypertensive patients with coronary heart disease [24][25][26].…”

Section: Discussionmentioning

confidence: 99%

Clinical profile and management of hypertensive patients with chronic ischemic heart disease and renal dysfunction attended by cardiologists in daily clinical practice

Barrios

Journal of Hypertension

Murga

et al. 2008

Self Cite

Renal function impairment is frequent in the hypertensive population with coronary artery disease. Patients with renal dysfunction represent a subgroup of very high-risk population with more risk factors and comorbidities and worse blood pressure control. The clinical profiles of hypertensive patients with renal function impairment are similar whether renal dysfunction is detected by high serum creatinine or by low estimated glomerular filtration rate.

“…On the other hand, as cardiovascular risk increases, a smaller proportion of patients attain BP goals, including those with renal dysfunction (Table 1). [31][32][33] Renin-angiotensin system inhibition and renovascular protection Although the renin-angiotensin-aldosterone system (RAS) plays a critical role in human physiology, and although angiotensin II, the RAS effector peptide, is essential for the homeostatic control of the cardiovascular system (including, among others, sodium and water balance, BP control, and cellular growth and replication), the excessive RAS activation is markedly associated with the establishment and progression of the cardiovascular continuum. 6,34,35 In fact, the excessive activation of the RAS has been implied in the progression of the entire cardiovascular disease continuum, from the early stages (hypertension and diabetes) to the middle (left ventricular hypertrophy and microalbuminuria) and late stages (coronary disease, stroke, heart failure, and renal disease).…”

Section: Importance Of Bp Controlmentioning

confidence: 99%

Emerging drug combinations to optimize renovascular protection and blood pressure goals

Echarri²,

Barrios³

2012

IJNRD

Self Cite

Hypertension and renal disease are closely related. In fact, there is an inverse linear relationship between renal function and prevalence of hypertension. Hypertensive patients with renal dysfunction exhibit a poor clinical profile, which markedly increases their risk for cardiovascular outcomes. This review considers the available evidence on the best therapeutic approach for optimizing renovascular protection in the hypertensive population. To effectively reduce or at least slow the establishment and progression of renal disease in the hypertensive population it is critical to reach blood pressure targets. Many studies have shown that angiotensinconverting enzyme inhibitors and angiotensin receptor blockers prevent or at least delay the development of microalbuminuria in patients with hypertension and type 2 diabetes, reduce the incidence of overt diabetic nephropathy, and are also beneficial in patients with nondiabetic renal disease. Therefore, renin-angiotensin system (RAS) inhibition plays a key role in the prevention of renal outcomes. As the majority of patients with hypertension will need at least two antihypertensive agents to achieve blood pressure goals, the use of RAS inhibitors is a mandatory part of antihypertensive therapy. The question of which antihypertensive agent is the best choice for combining with RAS blockers should be considered. Many studies have shown that diuretics and calcium channel blockers are the best choice. However, more studies are needed to clarify the subgroups of patients who will benefit more from a combination with a diuretic or from a combination with a calcium channel blocker. To date, RAS inhibitors recommended in this context are angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Aliskiren, the first oral direct renin inhibitor available, has shown promising results. Keywords: antihypertensive drugs, renin-angiotensin system, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, combined therapy Hypertension and renal diseaseHypertension is the most important modifiable risk factor for cardiovascular disease. It has been estimated that about 30% of the general population is hypertensive, a proportion that increases to two-thirds in the elderly.1 Remarkably, this prevalence is increased in patients with renal insufficiency. Thus, in a large cohort of Spanish patients enrolled in an ongoing prospective, observational, multicenter study of patients with stage 3 (n = 434) and 4 (n = 695) chronic kidney disease, hypertension was almost universal (91.2% and 94.1%, respectively). Moreover, proteinuria (.300 mg/day) was present in more than 60% of patients, without significant differences between stages 3 and 4 (1.2 ± 1.8 and 1.3 ± 1.8 g/day, respectively).2 In fact, there is an inverse linear relationship between renal function and prevalence of hypertension (from 66% at a glomerular filtration rate of 83 mL/minute per 1.73 m 2 of body surface area to 95% at