State of hypertension as We enter the 21st century : A societal conundrum

Effectiveness of hypertension treatment assessed by blood pressure level achieved in primary care setting in Poland

The effectiveness of hypertension treatment remains low in many developed countries. The aim of our study was to evaluate the treatment effectiveness in hypertensives treated by general practitioners (GPs) in Poland. Twenty thousand three hundred and five hypertensive patients (mean age 60.1 +/- 12.0 years, 9918 women, 10 387 men), pharmacologically treated by 677 GPs in Poland, were investigated. Blood pressure (BP) in every patient was measured twice, within approximately a 5-min interval, in a seated position, using a mercury sphygmomanometer, after a rest of at least 10 min. Mean blood pressure from both measurements was used for further analysis. Measurements were carried out by a GP in the office. Every physician investigated 30 consecutive hypertensive patients. Of the investigated hypertensive patients treated, 8.3% had systolic blood pressure (SBP) < 140 mmHg and diastolic blood pressure (DBP) < 90 mmHg (7.8% in women, 8.8% in men respectively; p > 0.05). Mean SBP in the investigated group was 161.9 +/- 20.4 mmHg, 162.7 +/- 20.8 mmHg in women and 161.1 +/- 20.1 mmHg in men, respectively; p < 0.05. Mean DBP was 95.4 +/- 11.0 mmHg. The difference between mean DBP in women (95.3 +/- 11.0 mmHg) and men (95.5 +/- 11.1 mmHg) was not significant, p > 0.05. Mean pulse pressure (PP) for the whole group was 66.5 +/- 16.3 mmHg. In this cohort, 26.7% of patients were treated with one, 37.6% with two, 26.7% with three, 8.2% with four and 0.8% with five antihypertensive drugs. Mean number of antihypertensive drugs prescribed for one hypertensive patient was 2.2 +/- 1.0. Effectiveness of hypertension treatment by GPs in Poland remained unsatisfactory despite frequent implementation of combined antihypertensive drug therapy.

Maligne und therapierefraktäre Hypertonie

Early occurences of organ damage, mainly in the cardiovascular system, the central nervous system, of the kidney or the retina, are hallmarks of a malign course in arterial hypertension. Peracute hypertensive emergencies can lead to a rapid deterioration of organ functions, a slower development is observed in patients with therapy-resistant forms of arterial hypertension. In the following article we discuss the historical trends in terminology and epidemiology, clinical symptoms, and possible causes for therapy-resistant hypertension. The latter mainly focuses on possible secondary forms of hypertension and on thoughts on therapy-resistance in primary, idiopathic arterial hypertension, as well as on possible therapeutic approaches.