title: [Strategies for improving blood pressure control in Italy: from global cardiovascular risk stratification to combination therapy. 2012 Position paper of the Italian Society of Hypertension].
abstract: Observational studies demonstrate that the proportion of treated hypertensive patients who attain the recommended blood pressure goals (140/90 mmHg) does not exceed 30-40%. Conversely, clinical trials have consistently shown that effective blood pressure control within the recommended targets can be achieved in 70-80% of treated hypertensive patients with different cardiovascular risk profile, especially when appropriate, effective and well tolerated combination therapies are used. In order to bridge the gap between current and optimal blood pressure control rates and to achieve a more effective cardiovascular prevention, the Italian Society of Hypertension has recently developed an interventional strategy that aims to approximate 70% of treated controlled patients by 2015. This ambitious goal can be realistically achieved by the appropriate use of modern aids and tools, also including the implementation of combination therapy, especially if this approach can be simplified into a single pill, now available in Italy. At present, 70-80% of hypertensive patients require combination therapies based on at least two classes of antihypertensive drugs to achieve the recommended blood pressure goals. It is therefore of paramount importance to implement this strategy in routine clinical practice. Among the different combination therapies, the use of combination strategies based on drugs inhibiting the renin-angiotensin system, such as angiotensin receptor blockers and angiotensin-converting enzyme inhibitors, combined with diuretics and/or calcium-channel blockers, have demonstrated to significantly reduce the rates of major cardiovascular events and discontinuations from prescribed therapies, resulting in higher antihypertensive efficacy and better tolerability than monotherapy. The present document of the Italian Society of Hypertension aims to provide main indications for implementing combination therapy in the clinical management of hypertension in order to improve blood pressure control in Italy.
authors.affiliation: Cattedra e Struttura Complessa di Cardiologia, Dipartimento di Medicina Clinica e Molecolare, Sapienza Universitá di Roma, Azienda Ospedaliera Sant'Andrea, Roma. massimo.volpe@uniroma1.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Volpe
authors.forename: Ettore
authors.initials: E
authors.lastname: Ambrosioni
authors.forename: Claudio
authors.initials: C
authors.lastname: Borghi
authors.forename: Santina
authors.initials: S
authors.lastname: Cottone
authors.forename: Cesare
authors.initials: C
authors.lastname: Cuspidi
authors.forename: Nicola
authors.initials: N
authors.lastname: De Luca
authors.forename: Francesco
authors.initials: F
authors.lastname: Fallo
authors.forename: Claudio
authors.initials: C
authors.lastname: Ferri
authors.forename: Alberto
authors.initials: A
authors.lastname: Morganti
authors.forename: Maria Lorenza
authors.initials: ML
authors.lastname: Muiesan
authors.forename: Riccardo
authors.initials: R
authors.lastname: Sarzani
authors.forename: Leonardo
authors.initials: L
authors.lastname: Sechi
authors.forename: Agostino
authors.initials: A
authors.lastname: Virdis
authors.forename: Giuliano
authors.initials: G
authors.lastname: Tocci
authors.forename: Enrico
authors.initials: E
authors.lastname: Agabiti-Rosei
authors.forename: Bruno
authors.initials: B
authors.lastname: Trimarco
authors.forename: Alessandro
authors.initials: A
authors.lastname: Filippi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mancia
mesh_terms: D002318:Cardiovascular Diseases; D003131:Combined Modality Therapy; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D007558:Italy; D018570:Risk Assessment