Prof. Robert Fagard,
J. Redon argued that chronic kidney disease is a high risk condition, in which treatment-resistant hypertension plays a major role, particularly when confirmed by ambulatory BP monitoring. In CKD stage 3-4, systolic office BP and 24-h BP were not controlled in respectively 63% and 86% of the patients, due to volume overload, sympathetic overactivity and structural vascular changes. The management of resistant hypertension involves amongst others, salt restriction and careful optimization of diuretic therapy with loop diuretics and spironolactone; the role of renal denervation is currently being assessed. According to R. Cifkova, hypertension complicates about 10% of pregnancies, either as pre-existing hypertension, gestational hypertension or, in case of significant proteinuria, pre-eclampsia, and is the major cause of maternal, fetal and neonatal morbidity and mortality. Women at risk for pre-eclampsia are advised to take 75 mg of aspirin/day from 12 weeks until birth. Pharmacological therapy, with exclusion of RAS blockers, is in general indicated when BP is > 150/95 mmHg, but a number of special conditions require treatment at 140/90 mmHg. Stroke is the major complication of hypertension and there is ample evidence that antihypertensive treatment reduces the incidence of stroke, A. Coca said. Whereas there is in general no evidence that BP should be lowered below 130/80 mmHg in hypertensive patients, this lower BP may have some benefit for the primary prevention of stroke, but this is not clear for prevention of recurrent stroke. The best management for high blood pressure during acute stroke is still under investigation. Finally M. Dorobantu discussed that there is probably a bottom level for cardiovascular risk reduction during antihypertensive treatment, but that certain antihypertensive agents provide clinical benefit independent of their effect on BP, with particularly emphasis on RAS blockers and calcium channel blockers.
From bench to practice: hypertension control
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