“Bring the message home” from ESH: Treat global risk, treat aggressively

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Reinforcing the main theme from the 16th European Meeting of Hypertension - global cardiovascular risk - Dr. D.L. Clement from Gent, Belgium, spoke in the last plenary session of the meeting on the topic of diabetes, hypertension, and the heart.

Clement reminded the audience that high blood pressure is the common denominator for cardiovascular (CV) risk and the principle message of the 12003 ESH-ESC hypertension guidelines is to treat total CV risk. He urged the audience to take immediate action even in patients with a blood pressure of 130/80 mmHg plus additional risk factors, who have a total CV risk similar to that in a patient with a blood pressure of 180/110 who would automatically be treated immediately.

D.L. Clement, Belgium

Peripheral arterial disease (PAD) plus diabetes is almost “a malignant situation” leading  to both micro- and macrovasculature changes plus generalized vascular changes. Claudication is an underestimated risk factor and is a “manifestation of lesions elsewhere in the body,” Clement stated. About 40% of patients with claudication have angina pectoris, and, according to the Lipids Research Clinics Study, their survival is reduced, even asymptomatic patients, with coronary artery disease and stroke the primary causes of death. Intermittent claudication is associated with a 2- to 3-times higher risk of death. The ASCOT study showed that PAD is reduced with treatment, particularly combination therapy.

“In your practice tomorrow” remember that the presence of the metabolic syndrome in a patient means a greatly increased risk for CV disease and its related morbidity and mortality, because these patients have nearly all of the CV risk factors. Clement reminded the audience that the office blood pressure for a patient with hypertension and diabetes should be 130/80 mmHg and he urged them to immediately treat any blood pressures above this level.

The necessity for proper blood measurement, in accordance with the ESH-ESC guidelines was reinforced. “Be aware that there is a marked discrepancy between blood pressure values measured at the home and office,” Clement stated. Ambulatory blood pressure monitoring can help to identify the aggressiveness required to lower blood pressure to goal levels.

Lifestyle changes must not be forgotten. Antihypertensive agents with favorable metabolic effects are required. Combination therapy, with at least 2-3 different drugs, is needed to treat to goal in patients with hypertension and diabetes.

Euroaspire II has shown an increase in obesity and a slight increase in smoking, a reduction in cholesterol levels, likely due to greater use of lipid lowering drugs, but no decrease in hypertension, compared to Euroaspire I. Renewed and aggressive efforts are needed to increase the numbers of people treated and controlled to goal blood pressure levels.