Hypertension management in patients with cardiovascular comorbidities

  • Eur Heart J. 2023 Jun 20;44(23):2066-2077. doi: 10.1093/eurheartj/ehac395.
Lucas Lauder  1 ,  Felix Mahfoud  1 ,  Michel Azizi  2  3  4 ,  Deepak L Bhatt  5 ,  Sebastian Ewen  1 ,  Kazuomi Kario  6 ,  Gianfranco Parati  7 ,  Patrick Rossignol  4  8  9 ,  Markus P Schlaich  10  11 ,  Koon K Teo  12 ,  Raymond R Townsend  13 ,  Costas Tsioufis  14 ,  Michael A Weber  15 ,  Thomas Weber  16 ,  Michael Böhm  1  17
Affiliations
  • 1. Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str. 1, 66421 Homburg, Germany.
  • 2. Université Paris Cité, INSERM CIC1418, F-75015 Paris, France.
  • 3. AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department, DMU CARTE, F-75015 Paris, France.
  • 4. FCRIN INI-CRCT, Nancy, France.
  • 5. Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA, USA.
  • 6. Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
  • 7. Department of Medicine and Surgery, Cardiology Unit, University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS, Milan, Italy.
  • 8. Université de Lorraine, INSERM, Centre d'Investigations Cliniques - Plurithématique 14-33 and INSERM U1116, Nancy, France.
  • 9. CHRU de Nancy, Nancy, France.
  • 10. Dobney Hypertension Centre, Medical School-Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia, Perth, WA, Australia.
  • 11. Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, WA, Australia.
  • 12. Population Health Research Institute, McMaster University, Hamilton, ON, Canada.
  • 13. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
  • 14. National and Kapodistrian University of Athens, 1st Cardiology Clinic, Hippocratio Hospital, Athens, Greece.
  • 15. SUNY Downstate College of Medicine, Brooklyn, NY, USA.
  • 16. Department of Cardiology, Klinikum Wels-Grieskirchen, Wels, Austria.
  • 17. Cape Heart Institute (CHI), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
PMID: 36342266 DOI: 10.1093/eurheartj/ehac395
Abstract

Arterial Hypertension is a leading cause of death globally. Due to ageing, the rising incidence of Obesity, and socioeconomic and environmental changes, its incidence increases worldwide. Hypertension commonly coexists with Type 2 Diabetes, Obesity, dyslipidaemia, sedentary lifestyle, and smoking leading to risk amplification. Blood pressure lowering by lifestyle modifications and antihypertensive drugs reduce cardiovascular (CV) morbidity and mortality. Guidelines recommend dual- and triple-combination therapies using renin-angiotensin system blockers, Calcium Channel blockers, and/or a diuretic. Comorbidities often complicate management. New drugs such as angiotensin receptor-neprilysin inhibitors, sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and non-steroidal Mineralocorticoid Receptor antagonists improve CV and renal outcomes. Catheter-based renal denervation could offer an alternative treatment option in comorbid Hypertension associated with increased sympathetic nerve activity. This review summarises the latest clinical evidence for managing Hypertension with CV comorbidities.

Keywords
Aortic valve stenosis; Atrial fibrillation; Cardiovascular comorbidities; Chronic kidney disease; Chronic obstructive pulmonary disease; Diabetes mellitus; Heart failure; Hypertension; Obesity; Stroke; Transient ischemic attack.