Hypertension, it changes. The new guidelines on high blood pressure from the European Society of Cardiology (Esc), just published after a year by those of the European Society of Hypertension (Esh), introduce an innovation destined to have an impact on Italian doctors and patients. First of all because they expand the number of Italians at risk by almost 10 million.
New category under the lens
If today there are around 18 million hypertensives living in Italy, many of whom are not perfectly controlled, according to the new guidelines the number of citizens to be monitored rises to 25-28 million. Alongside the actual ‘hypertensives’ (values from 140/90 mmHg upwards), to be treated unlike the ‘normotensive’ (from 120/70 mmHg downwards), European cardiologists are in fact shining the spotlight on a new category: that of people ‘with high blood pressure’ (maximum between 120 and 139 mmHg, minimum between 70 and 89 mmHg).
An entire session of the 125th National Congress of the Italian Society of Internal Medicine (Simi ), scheduled in Rimini from today 11 October to Sunday 13.
The new classification of cardiologists
“By adopting the new classification of the European Society of Cardiology – explains Giovambattista Desideri, secretary of Simi and professor of Internal Medicine and Geriatrics at the Sapienza University of Rome – the people who need attention because they are hypertensive or have high blood pressure become many more, more or less than half of the entire population. Suffice it to say that, according to data from the ‘Heart Project’ of the Higher Institute of Health, the average blood pressure of the Italian population in the 35-74 age group is 132/77 mmHg: values that can be classified. precisely as high pressure” for the Esc.
“In reality – specifies Desideri – it is a category of pressure that has always received much attention from internal medicine specialists, because hypertension is never an ‘on-off’ phenomenon, a switch, but a biological parameter with a linear and continues with cardiac events. The risk of stroke and heart attack, in other words, does not suddenly disappear below 140/90 mmHg of pressure. The new ESC guidelines therefore make a distinction into 3 groups”, summarizes the specialist: “That certainly to be treated (hypertensives, above 140/90 mmHg); certainly not to be treated, but to be followed over time (normotensives, below 120/70 mmHg); evaluating the characteristics of the person from time to time. “If patients with high blood pressure present an increased cardiovascular risk profile due to the presence of diabetes, dyslipidemia, overweight/obesity, renal failure, previous heart attack and more, or deduced from the cardiovascular risk cards – explains Desideri – then there is indication for treatment, despite not falling into the hypertensive category”.
What does the European Hypertension Society say instead?
But what do the Esh guidelines say? The European Society of Hypertension does not speak of ‘high blood pressure’, but of ‘normal-high blood pressure’ or ‘pre-hypertension’ (130-139 mmHg maximum, 85-89 mmHg minimum), a category which however requires attention and possibly to be treated. “With the ESC 2024 guidelines, therefore – points out Secretary Simi – what changes, rather than the concept, is the ‘wording’ which becomes more sensitizing. With the definition of patient with high blood pressure, the level of attention on these subjects is raised still not yet frankly hypertensive, but to be carefully assessed, considering their cardiovascular risk in a more structured way, to decide whether to start antihypertensive treatment anyway”.
As for the targets to be reached with the therapy, European cardiologists indicate a value of “120-129, but more towards 120”. An attitude defined by Simi as “more aggressive”. Although “naturally – Desideri points out – in the case of the elderly or frail patient, greater caution is expected. In this case, the new watchword of the therapeutic objective is Alara (As Low As Reasonably Achievable), i.e. the value lowest reasonably achievable in that particular person, a concept that introduces a personalization in the blood pressure objectives to be achieved with the treatment in relation to the specific characteristics of the individual, according to a management approach that has always been typical of the internal medicine specialist”. As for the type of treatment, Esc and Esh agree: both recommend “using pre-established combinations, i.e. a pill containing 2 or 3 active ingredients”, to “simplify the patient’s life and improve therapeutic adherence”.
“The greater emphasis placed by the new ESC guidelines on borderline blood pressure conditions – comments Giorgio Sesti, president of Simi – is part of the vision that effective primary prevention must be able to identify and treat cardio-metabolic risk factors as much as possible as early as possible with a global (holistic) approach. An internist is therefore the figure of a specialist capable of taking care of people with multiple cardio-metabolic risk factors, of carrying out correct profiling of the risk of clinical events, of evaluating whether there are any. initial signs of organ damage and to treat the various risk factors by evaluating drug interactions and choosing the best therapeutic strategies in light of people’s preferences and attitudes”.
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