High blood pressure is a major risk factor for cerebrovascular, cardiovascular and renovascular diseases, affecting millions of patients each year worldwide.
In the latest guidelines of the European Society of Hypertension (ESH)/European Society of Cardiology (ESC), published in 2013, high blood pressure (BP) is defined as a systolic blood pressure (SBP) ≥ 140 mmHg and/or a diastolic blood pressure (DBP) ≥ 90 mmHg, based on the evidence from randomized controlled trials (RCTs) that in patients with these BP values treatment-induced BP reductions are beneficial.
According to recent epidemiological surveys, overall prevalence of hypertension in the general population appears to be around 30-45%, with a steep increase with ageing.
The increase in BP values is associated with the development of cardiovascular (CV) morbidity and mortality. The ESH/ESC guidelines point out that the initial choice of antihypertensive medication should be based both on the magnitude of BP elevation, and on the concomitant level of total CV risk. According to these guidelines, total CV risk should be stratified in categories of low, moderate, high, and very high risk according to SBP and DBP, and prevalence of risk factors (RFs), asymptomatic organ damage (OD), diabetes, chronic kidney disease (CKD) stage or symptomatic cardiovascular disease (CVD).
Uncontrolled hypertension is associated with a significant increase in CVD-related morbidity and mortality, as well as with the development of renal impairment/failure. There is ample evidence that adequate BP control is associated with a significant reduction in the risk of acute cerebrovascular events, heart failure, ischaemic heart disease, and chronic kidney disease. A crucial factor in the success of antihypertensive treatment is represented by patient adherence to therapeutic regimens, which in the long term can also affect the prognosis. Adherence to antihypertensive medications has indeed been associated with improvements in BP control, as well as reduction of hospital admissions and overall healthcare costs. The efficacy, tolerability and reduced complexity of treatment regimens are key factors to improve therapeutic adherence.