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Best antihypertensive strategies to improve blood pressure control in Latin America: position of the Latin American Society of Hypertension

Coca, Antonioa; López-Jaramillo, Patriciob,c; Thomopoulos, Costasd; Zanchetti, Albertoeon behalf of the Latin American Society of Hypertension (LASH)

doi: 10.1097/HJH.0000000000001593
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Evidence from randomized trials has shown that effective treatment with blood pressure (BP)-lowering medications reduces the risk of cardiovascular morbidity and mortality in patients with hypertension. Therefore, hypertension control and prevention of subsequent morbidity and mortality should be achievable for all patients worldwide. However, many people in Latin America remain undiagnosed, untreated or have inadequately controlled BP, even where this is access to health systems. Barriers to hypertension control in low-income countries include difficulties in transportation to health services; inappropriate opening hours; difficulties in making clinic appointments; inaccessible healthcare facilities, lack of insurance and high treatment costs. After a review of the best recent available evidence on the efficacy and tolerability of antihypertensive drugs and strategies, the Latin American Society of Hypertension experts conclude that all major classes of BP-lowering drugs be available to hypertensive patients, because all have been shown to reduce major cardiovascular outcomes compared with placebo, and have shown to be associated with a comparable risk of major cardiovascular events and mortality when compared between classes. Within each class, no evidence whatsoever is available to show that one compound is more effective than another in outcome prevention. Therefore, the selection of individual drugs may be based mainly on the capacity of Latin American governments to obtain the lowest prices of the different molecules manufactured by companies with high production quality standards.

aHypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clinic (IDIBAPS), University of Barcelona, Barcelona, Spain

bResearch Institute, Fundación Oftalmológica de Santander and Medical School, Universidad de Santander, Bucaramanga, Colombia

cFacultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Quito, Ecuador

dDepartment of Cardiology, Helena Venizelou Hospital, Athens, Greece

eIstituto Auxologico Italiano, IRCCS, and Università degli Studi di Milano, Milan, Italy

Correspondence to Antonio Coca, MD, PhD, Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clinic (IDIBAPS), University of Barcelona, Villarroel 170, 08036 Barcelona, Spain. E-mail: acoca@clinic.ub.es

Abbreviations: ACE, angiotensin-converting enzyme; ARB, angiotensin type 1 receptor blocker; CVD, cardiovascular disease; DIU, diuretics; ESRD, end-stage renal disease; GITS, gastrointestinal therapeutic system; LIC, low-income countries; LMIC, low-middle income countries; MACE, major cardiovascular events; UMIC, upper-middle income countries

Received 6 July, 2017

Revised 12 September, 2017

Accepted 12 September, 2017

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