The biggest problem for controlling hypertension (high blood pressure) is compliance with treatment, states an editorial in this week’s Lancet.

“Despite very effective and cost-effective treatments, target blood pressure levels are very rarely reached, even in countries where cost of medication is not an issue. Many patients still believe that hypertension is a disease that can be cured, and stop or reduce medication when blood pressure levels fall.”

The risk of becoming hypertensive for a person in a developed country exceeds a “staggering” 90%, and the increasingly common combination and interaction of hypertension with obesity, diabetes and hyperlipidaemia, if left untreated for too long, leads to cardiovascular disease, stroke, renal failure and death.

The disease burden of hypertension is expected to massively increase in the coming years. In 2000, the estimated number of adults living with high blood pressure was 972 million; this is expected to increase to 1.56 billion by 2025. The Editorial says: “Lifestyle factors, such as physical inactivity, a salt-rich diet with high processed and fatty foods, and alcohol and tobacco use, are at the heart of this increased disease burden, which is spreading at an alarming rate from developed countries to emerging economies, such as India and China.”

The Editorial concludes: “Physicians need to convey the message that hypertension is the first, and easily measurable, irreversible sign that many organs in the body are under attack. Perhaps this message will make people think more carefully about the consequences of an unhealthy lifestyle and give preventative measures a real chance.”

The Seminar, authored by Dr Franz Messerli, Division of Cardiology, St Luke’s-Roosevelt Hospital Center, Columbia University, New York and colleagues, takes a detailed look at hypertension, its underlying causes and associated risk factors. The authors state that neither beta-blockers nor thiazide diuretics should be used as first line therapy in uncomplicated hypertension.

They conclude: “Most hypertensive patients need two or more drugs for blood-pressure control and concomitant statin treatment for risk factor reduction. Despite the availability of effective and safe antihypertensive drugs, hypertension and its concomitant risk factors remain uncontrolled in most patients.”

Source: The Lancet

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