Clinical Update: Find it, confirm it, treat it and monitor therapy effectiveness

HYPERTENSION: The main message in relation to hypertension according to cardiologist Dr Michael Conway is ‘find it, confirm it, treat it, monitor therapeutic effectiveness and add therapies if resistant’.

And make sure it is not secondary to arterial, renal and endocrine disease.

Hypertension is a major modifiable risk factor in the development of cerebrovascular disease, ischaemic heart disease, cardiac and renal failure. Normal BP 120/80mmHg is the product of cardiac output and peripheral resistance. Hypertension is a sustained increase in either one of these factors or both.

Reduction of blood pressure (BP) is more important than the choice of agent although individual agents are preferable in certain settings.

Effective treatment leads to a 42 per cent reduction in the risk of stroke and a 21 per cent reduction in cardiovascular mortality, but international studies continue to show that there is substantial under-diagnosis, inadequate treatment and poor rates of BP control. The majority of patients (more than 50 per cent) require more than one drug to control blood pressure.

Initiation of treatment is based on two criteria: the levels of systolic blood pressure, diastolic blood pressure and the total level of CVD risk. Hypertension can be broadly classified as ‘high renin’ or ‘low renin’ and is best initially treated by one of two categories of drugs, i.e. those which inhibit (ACE inhibitors, ARBs or beta-blockers) and those which do not inhibit (CCBs or diuretics) the renin-angiotensin system.

An interval of at least four weeks should be allowed, to observe the full response of any drug before moving to the next step. Less than 50 per cent of patients are controlled by monotherapy and more than two-thirds need a combination of two or more drugs to achieve optimal control.

While there is a high awareness of the guidelines available for the management of hypertension, greater efforts need to be made to implement them in clinical practice.

With the array of effective medications available, knowledge of their effects (beneficial and detrimental) and increased understanding of the benefit of intensive therapy, the condition requires a continued, intensive and dedicated approach. – Irish Medical Times