How to implement the new 2018 ESH/ESC guidelines for the management of arterial hypertension in patients with metabolic syndrome and diabetes?
Krystyna Widecka, Michał Janowski
Blood pressure (BP) control in hypertensive patients remains poor worldwide, particularly in high-risk patients with hypertension and diabetes. New ESH/ESC guidelines recommend more stringent BP targets (on-treatment values of ≤ 130/80 mm Hg in the general population and ≤ 140/90 mm Hg in older hypertensive people), which will make the achievement of BP control even more challenging. The most effective evidence-based treatment strategy to improve BP control is one that: encourages the use of
... bination treatment, enables the use of single-pill combination (SPC) therapy for most patients to improve adherence to treatment, with the use of SPC therapy as initial therapy. The combination of perindopril with thiazide-like diuretic indapamide is one of the widely tested SPC in multicentre clinical trials for diabetic patients. Studies suggested that two-drug combination therapy will control BP in approximately two-thirds of patients. For patients whose BP is not controlled by two-drug combination therapy, the logical option is to increase treatment to three-drug combination therapy: usually a RAS blocker, a CCB and a diuretic. The combination of perindopril with indapamide and amlodipine is particularly recommended in population of hypertensive patients with metabolic complications because of favourable, neutral effect on blood glucose and cholesterol level. This combination has proven hypotensive effect in group of patients with difficult-to-control hypertension. A new strategy for the treatment of hypertension Hypertension is currently the most important mortality risk factor in the world and a major public health problem, especially in developed countries. It is esti-mated that currently there are over one billion people living with hypertension worldwide, and by 2025 this number is predicted to increase by 60% [1, 2] . Thanks to the advances in antihypertensive drug therapy we can effectively lower blood pressure in 157 www.ah.viamedica.pl individual patients and, thereby, reduce the main risk factor of cardiovascular (CV) events. Despite this, epidemiological studies clearly indicate poor blood pressure control in the whole population. The lowest rate of adequate control of hypertension is observed among patients with diabetes, chronic kidney disease, stable angina, acute coronary syndrome and left ventricular dysfunction    . The authors of the 2018 European Society of Hypertension/European Society of Cardiology (ESH/ /ESC) guidelines emphasize that their main goal was to develop a strategy that ensures improved blood pressure (BP) control in treated patients. The most important elements of this strategy are: