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Unmet Needs in Hypertension Therapy

Written by M. Mohsen Ibrahim, MD
Friday, 14 October 2016

President's Message

Unmet Needs in Hypertension Therapy

In spite of advances in pharmacologic therapy of hypertension and the presence of more than 11 different pharmacologic groups, still hypertension morbidity and mortality is high compared to normotensive subjects. This seems to be secondary to a number of reasons.

First we fail to achieve optimal blood pressure control in the majority of patients and even in developed countries it is less than 50%, while in developing countries it is 8% or less. Failure to achieve optimal blood pressure control is responsible for 60% of cardiovascular accidents, 50% of coronary events, and 7.1 million deaths/year. It is predicted that over the next 10 years, health costs of non- optimal blood pressure are likely to reach over $908 billion, if blood pressure remains at current levels. The reasons of this failure are related both to limitation of available drug therapy and patients non- compliance.

Second, hypertension comes in the majority of patients associated with other comorbidities and risk factors such as diabetes, dyslipidemia, impaired glucose tolerance, hyperinsulinemia, obesity and a systemic pro-inflammatory state. Even in adequately treated hypertensive patients, in spite of normalization of blood pressure, the long-term survival after two decades is less than normotensive healthy subjects of equal age. Majority of available drugs fail to address other cardiovascular risk factors associated with hypertension. Treated hypertensive patients with diabetes still have two-to-five fold higher rate of deterioration of renal function versus rate expected from ageing.

Third, failure to complete correction of residual damage and interrupting the progression of end-organ damage is another shortcoming of therapy. Cardiac, renal and vascular complications still develop. Despite blood pressure control, hypertensive patients may remain at elevated risk.

Fourth, in spite of the safety of the majority of available antihypertensive drugs, side effects develop and some degree of collateral damage may be present. Adverse effects secondary to therapy include metabolic changes, electrolyte disturbances, excessive hypotension and syncope, sexual dysfunction and deterioration of renal function.

Finally, at our present state of knowledge, current treatment of hypertension is empirical, choice of therapy is by trial and error. The most difficult unmet need in hypertension is possibly to develop a rational treatment and control of the processes leading to overt hypertension. The difficulty stems from the complexity of different pathogenic mechanisms secondary to interaction of genetic and environmental factors.

President of the Egyptian Hypertension Society

M. Mohsen Ibrahim, MD

Prof. of Cardiology- Cairo University

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Last Updated Friday, 14 October 2016