Do we need more than just powerful blood pressure reductions? New paradigms in end-organ protection

Review

(2159) Views  (1919) Full article downloads

Authors: Domenico Galzerano, Cristina Capogrosso, Sara Di Michele, et al

Published Date June 2010 Volume 2010:6 Pages 479 - 494

DOI: http://dx.doi.org/10.2147/VHRM.S7969

Domenico Galzerano¹, Cristina Capogrosso¹, Sara Di Michele², Emanuele Bobbio³, Paola Paparello¹, Carlo Gaudio²

¹Department of Cardiology, San Gennaro Hospital, Naples, Italy; ²Department of Heart and Great Vessels, A. Reale, La Sapienza University, Rome, Italy; ³Department of Cardiovascular Sciences, Federico II University, Naples, Italy

Abstract: Antihypertensive therapy can lower the risk of cardiovascular morbidity and mortality. Yet, partly because of inadequate dosing, wrong pharmacological choices, and poor patient adherence, hypertension control remains suboptimal in the majority of hypertensive patients. Achieving greater blood pressure control requires a multifaceted approach that raises awareness of hypertension, uses effective therapies, and improves adherence. Particular classes of antihypertensive therapy have beneficial actions beyond blood pressure and studies have evaluated differences in cardiovascular protection among classes. The LIFE and HOPE studies showed between-class differences that may be due to effects other than blood pressure-lowering. In the ONTARGET study, telmisartan and ramipril provided similar cardiovascular protection but adherence was higher with telmisartan, which was better tolerated. This difference in compliance is likely to be important for long-term therapy. The selection of an agent for cardiovascular protection should depend on an appreciation of its composite properties, including any beneficial effects on tolerability and increased patient adherence, as these are likely to be advantageous for the long-term management of hypertension. This review examines the evidence that the effects beyond blood pressure provided by some antihypertensive agents can also lower the risk of cardiovascular, cerebrovascular, and renal events in patients with hypertension.

Keywords: angiotensin II receptor blocker, cardiovascular continuum, cardiovascular disease, hypertension, renin–angiotensin system, telmisartan

Other articles by Dr Domenico Galzerano