Sebastian Ewen asks questions to Anton H. van den Meiracker, the author of "A global approach to hypertension " article published in EuroIntervention Journal Supplement on Resistant Hypertension Treatments, May 2013.
Hypertension is an extremely common condition and quantitatively the most important risk factor for cardiovascular disease and mortality. Cardiovascular risk factors other than hypertension occur more frequently in hypertensive subjects and contribute to the elevated cardiovascular risk. Management of hypertensive subjects includes lifestyle modification and, usually, treatment with antihypertensive agents. Due to the limited blood pressure lowering effect of a single antihypertensive agent, more than 2/3 of hypertensive patients require at least two or more antihypertensive agents to achieve target blood pressure. For combination therapy combining an agent that interferes with the renin-angiotensin system with an agent that does not is recommended. Treatment adherence and persistence can be improved by using fixed-dose combinations instead of single agents.
Sebastian Ewen: What makes hypertension the most important risk factor for cardiovascular mortality worldwide?
Anton H. van den Meiracker: The extremely high prevalence among the adult population.
Sebastian Ewen: How important is the lifestyle modification for the treatment of high blood pressure?
Anton H. van den Meiracker: Always important. However in severe hypertension medical treatment is almost always required.
Sebastian Ewen: Based on your experience, how many patients (in percentage) are willing to work on their body weight, lower their salt intake < 3g/d, quit smoking and minimize their alcohol consumption?
Anton H. van den Meiracker: Less than 20%. The salt intake of < 3 g/day is not realistic. About 6 gram per (100 mmol of sodium per day) should be possible.
Sebastian Ewen: What do you prefer - doubling the standard dose of a hypertensive agent or a combination of two agents from different classes?
Anton H. van den Meiracker: Almost all antihypertensives have a flat dose-response curve. Combination treatment is preferred over high doses of monotherapy.
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