VIDEO – Arterial hypertension is an extremely frequent cardiovascular risk factor and which exposes to a risk of vascular accidents, mainly coronary and cerebral. The problem is that hypertension is more and more frequent and, unfortunately, not always well treated.
Although not the greatest in terms of absolute risk, high blood pressure is the most common and dangerous cardiovascular risk factor in the world. This is explained by its pejorative impact on the arteries and the resulting cardiovascular accidents, either because hypertension is directly linked to these accidents (stroke), or because it is associated with other risk factors such as cholesterol or diabetes, or even tobacco.
One in three people affected
In our Western societies, hypertension would indeed concern one in three people. This is already a huge figure, but with the aging of the population, hypertension is a risk factor whose frequency is inevitably increasing. It is estimated that over the age of 65, 60% of the population is hypertensive.
This hypertension affects in particular the systolic blood pressure due to a stiffening of the arteries, which then no longer play their role of shock absorber of the pulse wave, but there are also systolodiastolic arterial hypertension whose mechanism is more complex.
Many accidents
Because of its high frequency, hypertension is therefore the risk factor responsible for the greatest number of deaths and disabilities in the world. It is indeed the first risk factor for cerebrovascular accidents, which are themselves the cause of too many neurological sequelae.
It is also a risk factor which participates in the development of atherosclerosis, the disease which affects all the arteries, whether cerebral or coronary, but also the aorta, the arteries of the limbs… This is the first risk factor for aortic aneurysm and its risk of rupture.
Insufficient treatment
This cardiovascular burden is all the more acute as half of hypertensive patients in Europe are not treated. Moreover, among those who are treated, less than 40% are at the objectives defined by the consensus, namely 14/9, in the absence of an associated risk factor.
So, beyond screening people with hypertension in order to treat them before the stage of complications, there is also a problem of optimizing the treatment, either because of the inertia of the doctor or the patient to increase the treatment, or due to a mismatch of the prescribed treatment to the form of hypertension, or due to a lack of molecules targeting therapeutic pathways different from those currently targeted.
Difficult-to-treat hypertension
This problem of hypertension, which is difficult to treat, is a real challenge and it even goes as far as resistant hypertension. Resistant hypertension refers to people who remain hypertensive despite taking three different antihypertensives including at least one diuretic. It concerns nearly one patient in 10.
Apart from hypertension secondary to a disease (hyperaldosterolism, pheochromocytoma, hypercorticism, etc.), the treatment of which obviously depends on the disease responsible, resistant hypertension has no resistance other than that which it has against to the current pharmacopoeia. A challenge for medical research.
The treatment of hypertension is undergoing a revolution and it is essential because there are many unmet needs in this disease and doctors are impatiently awaiting new molecules.
Interview with Pr Pasquale Perrone Filardi, cardiologist at the University of Naples, Italy
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