Document Detail


Treating high blood pressure: is reaching the target more important than the means? Yes, the target is more important.
MedLine Citation:
PMID:  21111929     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
The effectiveness of hypertension treatments is attributed either to the change in blood pressure, independent of the means used, or to an important contribution of appropriate drug selection: this debate probably stems from an inappropriate comparison. Treating essential hypertension in relatively healthy patients without advanced vascular disease and co-morbidities affords cardio-vascular protection by the lowering of the mechanical shear stress determined by blood pressure per se: thus, lowering blood pressure is the critical step, while the methods used can only differ through side effects. This treatment is, in fact, a lifetime prophylaxis, as hypertension, rather than a disease, is a symptom affecting one tail of the Gaussian distribution of blood pressure across the normal population. Treating hypertension in the context of diseases, like diabetes mellitus, congestive heart failure, left ventricular hypertrophy, and advanced atherosclerosis, would be improper if focused on just one symptom, while the appropriate treatment must include options which exhibit a more extended profile to include effectiveness on cardiac hypertrophy, insulin resistance, cardiac output, and systemic hemodynamics: thus, drugs may be different in their effectiveness and in the cardio-vascular protection afforded, even though the trials quoted in favour of this thesis were designed to compare drugs in their ability to lower blood pressure rather than in improving the overall complex clinical derangements. In conclusion, while the answer to the question is a sharp YES when dealing with primary prevention, it might be a NO, still clouded by contradictory and inconclusive evidence when dealing with secondary prevention and/or treatment of complex disease conditions and co-morbidities.
Authors:
Ettore Bartoli; Gian Piero Carnevale Schianca; Pier Paolo Sainaghi
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Publication Detail:
Type:  Journal Article     Date:  2010-10-27
Journal Detail:
Title:  European journal of internal medicine     Volume:  21     ISSN:  1879-0828     ISO Abbreviation:  Eur. J. Intern. Med.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9003220     Medline TA:  Eur J Intern Med     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  473-7     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
Affiliation:
Internal Medicine, Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi del Piemonte Orientale A. Avogadro, Via Solaroli, 17, 28100 Novara, Italy. bartoli@med.unipmn.it
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