Management of hypertension and cardiovascular disease prevention

 Alberto Zanchetti
Centro di Fisiologia Clinica e Ipertensione
University of Milan Istituto Auxologico Italiano, Milan
Editor-in-Chief, Journal of Hypertension

 Cardiovascular diseases, including ischaemic heart disease and stroke are the leading causes of death worldwide. In Europe and in countries with developed economies they are responsible for more than 40% of yearly deaths¹. High blood pressure, the major cardiovascular risk factor, has also been found the leading cause of mortality worldwide, and ranks high also in developing regions of the world². It has been calculated that 972 millions of the world population (333 in developed regions and 639 in developing regions) had high blood pressure in 2000, but these figures are expected to increase by 2025, when there will be 1.56 billion hypertensives of whom more than 1 billion in the developing parts of the world³.

The cost of cardiovascular diseases is very high, both to the individual patient and to societies. It has been calculated that the estimated direct and indirect costs of stroke, the most ominous consequence of hypertension, have been of US $ 53.6 billion only in the USA during 2004.

Cardiovascular diseases, including stroke, are preventable diseases, since some of its most important causative factors, such as hypertension and tobacco smoking, can be corrected. Antihypertensive treatment has been one of the most outstanding successes of medicine in the second half of the 20th century. The Journal of Hypertension, the official organ of both the International and the European Societies of Hypertension, is dedicated to original basic and clinical research on hypertension and its cardiovascular and renal complications. 

In the last 15 years it has published guidelines prepared by these scientific Societies^4,5,6 and the World Health Organization⁴, and thus contributed to spreading evidence based recommendations for health prevention. The most recent guidelines of the European Society of Hypertension, published in the September 2009 issue of the Journal, concern high blood pressure in children and adolescents. These are the first guidelines in Europe on the management of this condition, which raises increasing concern worldwide. The text of these guidelines is freely available form the website of the Journal of Hypertension⁷. Other interesting articles can be found in the July and August issues, and concern the cost of insufficient control of blood pressure⁸ and the high residual cardiovascular risk remaining when antihypertensive therapy is started late⁹. 

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