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Hypertension is one of the primary cardiovascular (CV) risk factors. Blood pressure (BP) lowering treatments can reduce the occurrence of myocardial infarction, stroke, heart failure and CV and all-cause mortality.
The detection of high BP is an important step in any CV prevention strategy with excellent health benefits. However, many patients are still ignorant of their diagnosis and are left untreated or do not receive therapeutic treatments to control the BP within normal limits. Several reasons are advocated to explain the persistent poor control of BP. Late or ineffective treatment might have a role in irreversible adaptations of the CV system.
The main objective of this review article was to assess the effects of early and effective BP control in hypertension while exploring various studies and provide physicians with the existing data that support the benefit of early BP control.
Evidence that was derived from the Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT) propose that the achievement of BP control within 6 months is related with a significant decline in the occurrence of stroke.
A meta-analysis of the BP Lowering Treatment Trialists Collaboration has examined the data of grade 1 hypertensive patients with low-to-moderate CV risk from almost 10 randomized clinical trials. The outcomes of the pharmacological treatment were associated with a significant reduction of CAD, stroke and CV and all-cause mortality, independently from concomitant risk factors and baseline BP levels. Numerous studies have shown that approximately 60% of untreated pre-hypertensive patients develop hypertension within 4 years along with a 3-fold higher risk than in individuals with BP values <120/80 mm Hg. Therefore, prehypertension should be clinically monitored and eventually treated particularly when the total risk is projected.
Often, a single-drug therapeutic regime is insufficient to achieve an early BP control, particularly in patients with higher baseline BP levels and added CV risk factors. Many studies have demonstrated that initiation with a dual combination, as a single-pill, is associated with an early and better antihypertensive effect and persistent BP control in one-year follow-up.
Thus, in conclusion, early initiation of an antihypertensive treatment is associated with a greater effective and more lasting BP control. It also reduces the effect of increasing CV risk exposure. A quick achievement of BP control leads to greater CV benefits. Also, the early use of fixed-combination treatments, specifically in a single pill, can be a preferred choice to attain the objective.
Source: Volpe M, Gallo G, Tocci G. Is early and fast blood pressure control important in hypertension management? Int J Cardiol. 2018; 254:328-332. doi:10.1016/j.ijcard.2017.12.026