고혈압 치료의 변화

Abstract

Hypertension is one of the most significant but modifiable risk factors for cardiovascular disease. Previous clinical trial clearly showed that blood pressure reduction effectively decreased the incidence of cardiovascular and cerebrovascular events. Despite the improvement of hypertension treatment, the overall control rate of hypertension has not yet been clearly improved. The proportion of hypertensive patients who have their blood pressure controlled has increased dramatically during the past several decades; however, a lot of patients still did not reach the optima goal. In addition, other cardiovascular risk factors such as dyslipidemia, diabetes, and chronic kidney disease rapidly increased recently. As such, the proper control of the risk factors is much more important in high risk hypertensive patients. The control of hypertension continues to be inadequate despite the effective, well-tolerated medications. The control rates are even worse among the high risk patients, to whom target blood-pressure levels of 130/80 mm Hg or lower are recommended. In order to improve the level of blood pressure control in the population, we should enhance the awareness and treatment of hypertension through public health education. In addition, aggressive combination therapy including diuretics, overcoming therapeutic inertia, and screening for primary aldosteronism is warranted in all the hypertensive patients. Novel therapeutic approach for hypertension such as immunization against angiotensin II or renal denervation has gained much attention. In condusion, despite recent advance in pharmacological therapeutics, the rate of hypertension control is still far from satisfactory. Lower treatment thresholds and more intensive treatment contribute to better hypertension control. In particular, much more efforts are needed to encourage the use of low-cost thiazide diuretics as antihypertensive agents in patients taking more than three anti-hypertensive medications.