Raised blood pressure is a major risk factor for cardiovascular disease. The higher the blood pressure, the higher the risk of stroke, coronary heart disease, kidney disease, heart failure and death. This relationship applies across the whole range of blood pressures usually encountered in clinical practice. Systolic blood pressure is a stronger and more consistent predictor of cardiovascular risk than diastolic blood pressure. Standard procedures and several visits are needed to assess clinic blood pressure and achieve appropriate management. Consideration should also be given to obtaining blood pressure measurements outside the clinic, either by home or ambulatory blood pressure monitoring.
The ultimate goal of treatment of hypertension is to reduce the cardiovascular, cerebrovascular and renal morbidity and mortality. The aim must be to achieve targets of below 140/90. However in patients with diabetes or renal disease the goal should be less than 130/80.
b) Coexisting Conditions
Angina
The importance of treatment of hypertension in ischemic heart disease is that this itself produces relief of angina in many cases. The added benefit is that the usual antihypertensives used such as beta blockers and calcium channel blockers provide anti anginal effects also.
Chronic Obstructive Pulmonary Disease (COPD)
The important precaution to take when treating patients with COPD is the avoidance of beta blockers due to their bronchoconstrictive effects. Selective blockers like bisoprolol and metoprolol may be carefully tried if absolutely indicated. However, even these drugs are dose dependent on their selectivity.
Diabetes
In the Indian scenario, in a large proportion of cases, diabetes is part of the Metabolic Syndrome X, of which hypertension is an integral constituent, along with dyslipidemia and central obesity.
LV Failure
In cardiac failure the true degree of hypertension may be masked because the BP may be low due to the low cardiac output. The optimum use of ACE inhibitors and some AR Blockers makes substantial contribution in the relief of heart failure. In certain cases of chronic heart failure the addition of Carvedilol and Bisoprolol has been found to decrease the morbidity.