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Blood pressure control in hypertension. Pros and cons of available treatment strategies

Mancia, Giuseppe; Rea, Federico; Cuspidi, Cesare; Grassi, Guido; Corrao, Giovanni

doi: 10.1097/HJH.0000000000001181

The low rate of blood pressure (BP) control that characterizes the hypertensive population in real life is traditionally associated to factors such as low adherence of patients to the prescribed treatment regimen, physicians’ therapeutic inertia, and deficiencies of the healthcare systems. This study will focus on a fourth factor that may also be importantly involved, i.e. reluctance to adopt drug treatment strategies that more effectively reduce an elevated BP. The point will be made that, vis-à-vis strategies based on patients’ persistence in monotherapy, drug combinations are accompanied by a much more frequent BP control. In particular, it will be argued that compared with the administration of additional drugs after initial monotherapy, use of combination treatment from the beginning may carry important advantages, such as a faster BP control, and thus an earlier protection in patients at a high cardiovascular risk and a better adherence to the prescribed drugs and thus a more frequent long-term achievement of target BP values, possibly also with a more effective cardiovascular protection. This may justify a more clear support of this treatment strategy by future guidelines, in the attempt to lessen the contribution of hypertension to cardiovascular disease and death.

aUniversity of Milano-Bicocca

bIRCCS Istituto Auxologico Italiano, Italy

cDivision of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods

dDepartment of Health Sciences, University of Milano-Bicocca

eIRCCS Multimedica, Sesto San Giovanni, Milan, Italy

Correspondence to Professor Giuseppe Mancia, Piazza dei Daini, 4, 20126 Milano, Italy. Tel: +39 3474327142; e-mail:

Abbreviation: BP, blood pressure

Received 7 July, 2016

Revised 4 September, 2016

Accepted 12 October, 2016

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