◆Diagnosing and Treating Hypertension in Europe


To improve the present low control rates for hypertension in Europe, doctors should improve the way they treat hypertension, Professor Mancia believes. This means that they should not diagnose hypertension too quickly; otherwise they will see what could be a transient increase in blood pressure due to an alerting reaction and treat patients who may not be really truly hypertensive. Rather, they should diagnose hypertension more accurately, according to Mancia. They should also be more persevering in the way they treat patients. "One concept that we would like to put through is that blood pressure should definitely be reduced below 140/90 mm Hg in all subjects, and doctors should not stop their efforts to lower blood pressure before they have reached the target," Professor Mancia said, adding that patient compliance is extremely important. However, he cautioned that there is an inherent limitation in the hypertension condition, which is that patients do not have an immediate benefit.

Professor Mancia added that this "delayed benefit" is why appreciation of subclinical organ damage is important in the guidelines. Subclinical organ damage - eg, left ventricular hypertrophy, microalbuminuria, modest reduction in renal function, carotid artery wall thickening, or arterial sclerotic plaques - can all be slowed or reversed by antihypertensive treatment, and these data give a measure of long-term protection. They can also serve the doctors in terms of improving compliance, Professor Mancia believes, because doctors can use the measures of subclinical organ damage to demonstrate to patients that things are going well. Using these measures, the physician can report "progress" because arteries remain thin and the heart maintains its weight and shape. This gives the patients something positive to think about and a way to receive positive feedback so that their attitude toward treatment may change.

编辑 郑麓薇