ACTA FAC. MED. NAISS. 2004; 21 (1): 1-8

 Reviewl article
 

    MANAGEMENT OF ARTERIAL HYPERTENSION

    Stevan Ilić, Marina Deljanin Ilić
    Institute for prevention, treatment and rehabilitation of rheumatic and cardiovascular diseases, Niška     Banja

    SUMMARY    

    At the begining of a new millennium, more than 50% of people, 65 years of age or older, have arterial hypertension. According to the frequency of physician visits, arterial hypertension occupies the first place among all chronic diseases. Numerous studies have showed that good control of hypertension significantly reduced the risk of both cardiovascular morbidity and mortality. In recent years, several quidelines on diagnosis, examination and treatment of patients with arterial hypertension have been published. The aim of this paper is a short review of European guidelines for the management of arterial hypertension (European Society of Hypertension - ESH and European Society of Cardiology - ESC), which was published in 2003.
    Normal values of systolic blood pressure are up to 139 mmHg and for diastolic pressure up to 89 mmHg. There are three categories of normal blood pressure: optimal, normal and high normal. There are three stages of arteraial hypertension: mild, moderate and severe, while isolated systolic hypertension is separated (systolic blood pressure 140 mmHg and diastolic < 90 mmHg). European guidelines contrary to JNC 7 (American guidelines for hypertension) do not suggest a term "prehypertension" for individuals with systolic blood pressure 120 - 139 mmHg or diastolic 90 - 99 mmHg. Risk stratification is an important part of recommendations and it was done according to the presence of other risk factors, target organ damage and rejoined diabetes as well as other clinical conditions. In order to diagnose arterial hypertension, apart from anamnesis and clinical examination with repeated blood pressure measurements, it is necessary to include some laboratorial tests which may be routine, recommended or expanded (for more complicated forms of hypertension or for determining the cause of secondary hypertension).
    The primary goal of arterial hypertension treatment is to achieve maximal reduction of global cardiovascular risk for morbidity and mortality. Blood pressure values should be reduced to less than 140/90 mmHg; in diabetic patients it should be reduced under 130/80 mmHg. The decision for the treatment onset refers to initial values of blood pressure and global cardiovascular risk as well. In the treatment of patients with arterial hypertension the change of lifestile is necessary and enough in some cases (to give up smoking, body - weight reduction, excessive alcohol intake, regular aerobic physical activity, less salt intake and increased intake of fruit and vegetables). If the expected values of blood pressure are not reached by applying the measures of changed life style, a therapy by drugs is introduced. If blood pressure values are high or if the risk is high, the measures of changed life style are applied along with medicaments. In relation to cardiovascular risk, presence of target organ damage, rejoined clinical conditions and cost of drug, some of five major classes of antihypertensive agents: diuretics, beta - blockers, calcium antagonists, ACE inhibitors and angiotensin receptor antagonists is chosen. In specific indication alfa - blocker may also be recommended.

    Key words: arterial hypertension, cardiovascular risk, antihypertensive drugs