Arterial hypertension.

Department of Cardiology, Cardiovascular Center Aalst, OLV Hospital Aalst, Aalst, Belgium; Department of Experimental Pharmacology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium. Electronic address: sofie.brouwers@olvz-aalst.be. University Heart Center, Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan; Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK. Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, TX, USA.

Lancet (London, England). 2021;(10296):249-261
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Abstract

Arterial hypertension is the most important contributor to the global burden of disease; however, disease control remains poor. Although the diagnosis of hypertension is still based on office blood pressure, confirmation with out-of-office blood pressure measurements (ie, ambulatory or home monitoring) is strongly recommended. The definition of hypertension differs throughout various guidelines, but the indications for antihypertensive therapy are relatively similar. Lifestyle adaptation is absolutely key in non-pharmacological treatment. Pharmacologically, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, calcium channel blockers, and diuretics are the first-line agents, with advice for the use of single-pill combination therapy by most guidelines. As a fourth-line agent, spironolactone should be considered. The rapidly evolving field of device-based therapy, especially renal denervation, will further broaden therapeutic options. Despite being a largely controllable condition, the actual rates of awareness, treatment, and control of hypertension are disappointingly low. Further improvements throughout the process of patient screening, diagnosis, treatment, and follow-up need to be urgently addressed.

Methodological quality

Publication Type : Review

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