Managing hypertension in cardiology practice according to risk profile

Abstract

Cardiologists play a central role in managing hypertensive patients, although recent surveys reveal a marked discrepancy between cardiologists' appreciation of their patients' risk status and the measures taken to reduce that risk. The diagnosis and the management of hypertension, in fact, must be viewed today not in isolation, but as part of a patients' global cardiovascular (CV) risk, resulting from the concomitant presence of a variety of risk factors, organ damage (left ventricular hypertrophy, carotid or peripheral atherosclerosis, microalbuminuria or impaired glomerular filtration rate), and hypertension-related clinical conditions. The choice of timing and the intensity of antihypertensive treatment should be based on blood pressure (BP)-lowering efficacy and the propensity to favourably impact patient's individual absolute CV disease risk profile. As part of this paradigm shift in CV disease prevention strategy, cardiologists can take several key steps to help improve standards of hypertension control: (i) increase the awareness of total risk management; (ii) initiate an integrated management strategy tailored to the individual patient's global CV risk (e.g. hypertension, hypercholesterolaemia, diabetes, age, smoking and gender); (iii) use any elevation in BP as a gateway to begin total risk management and (iv) utilise combination therapies (particularly fixed-dose combinations) to achieve more rapid and persistent BP control and improve patient compliance/persistence with therapy. To help improve standards of hypertension control in the cardiology setting, this review examines the concept of treating hypertension using a global risk assessment approach and proposes effective hypertensive therapy as part of global risk management in patients typically seen in cardiology practice.

Vitamin D in Neurological Diseases: A Rationale for a Pathogenic Impact

“…Chung et al (225) demonstrate that vitamin D is inversely associated with lacunes, white matter hyperintensites and deep microbleeding, in profound white matter, not elsewhere, suggesting a high impact on small vessel disease. Moretti et al (226) hypothesize that vitamin D might act on the altered control of CBF [249][250][251][252][253][254] and in the distorted neurovascular coupling system [255][256], both heavily impaired in small vessel dementia. Intracerebral calcium, intimately regulated by vitamin D, interferes with vessel activation.…”

Combination Therapy for the Clinical Management of Hypertension

“…In addition, recommendations from national (local) and international guidelines should always be taken into account when starting any antihypertensive strategy, because they are based on the results of randomized controlled clinical trials, which have tested the clinical effi cacy, safety and tolerability of different drug classes according to the principles of the modern evidence-based medicine [ 12 , 13 ]. Also, probability to experience a drug-related adverse reaction or an adverse event to prescribed antihypertensive medication, as well as tolerability and safety profi le of each selected drug class or molecule may impact the decision on when, how and how much to treat individual hypertensive patients [ 19 ]. Furthermore, these factors may infl uence persistence and adherence of patients to prescribed antihypertensive drugs [ 20 ] (Chap.…”

“…This may help in defi ning different forms of hypertension (e.g. isolated clinic hypertension, 'early morning' hypertension, 'masked' hypertension, 'sustained' hypertension, resistant or pseudo-resistant hypertension) [ 18 ], as well as to better identify the most appropriate therapeutic options among currently available antihypertensive drug classes [ 19 ]. In addition, recommendations from national (local) and international guidelines should always be taken into account when starting any antihypertensive strategy, because they are based on the results of randomized controlled clinical trials, which have tested the clinical effi cacy, safety and tolerability of different drug classes according to the principles of the modern evidence-based medicine [ 12 , 13 ].…”

An Analysis of the Management of Cardiovascular Risk Factors in Routine Clinical Practice in Italy

“…Among other factors linked to time constraints during the visit, incomplete awareness of the efficacy of profiling the risk of patients and of timely interventions, inadequate knowledge and application of guidelines and recommendations for cardiovascular risk management may also be reported. [6] A global survey conducted on 825 general practitioners (GPs) from different countries worldwide (n = 75 Italians), recently confirmed an insufficient knowledge and discrepant behaviours, as far as cardiovascular risk management is concerned. [7] A more recent survey on cardiovascular risk perception and management by cardiologists also confirmed that there is room for improvement when treating cardiovascular diseases.…”