Wednesday, May 19, 2021 — The annual World Hypertension Day on 17 May prompted the publication of a review article on hypertension that appears today in the leading journal The Lancet. In this article, Prof Sofie Brouwers, OLV Ziekenhuis Aalst and Vrije Universiteit Brussel, and her colleagues present the current state of affairs regarding arterial hypertension.
It is estimated that, worldwide, more than 10 million people die each year as a result of high blood pressure and related diseases. This corresponds to about three times the number of official deaths due to Covid-19 since the beginning of the pandemic, making high blood pressure, or hypertension, the leading cause of cardiovascular disease and premature death worldwide. Although the condition can be relatively well controlled, much remains to be done. One in four adults has hypertension, but despite current knowledge and the existence of good treatments, only half of the patients who are diagnosed with hypertension eventually get it under control.
In their review article, the authors emphasise the importance of a multidisciplinary approach to hypertension. Brouwers: "In Belgium, first-line care is almost exclusively provided by general practitioners, who play a crucial role in the detection, treatment and follow-up of hypertension patients. This system works relatively well, but a more complete approach to the problem is certainly needed. This should involve building networks between the general practitioner, pharmacist and hypertension specialist, which could further optimise the care for hypertensive patients."
Digital tools can help
The authors also point to a new ally in the battle against high blood pressure: digital and mobile health. The use of mobile health applications is a useful for self-management and encourages the patients to be involved in the follow-up and treatment of their blood pressure. Monitoring blood pressure at home plays an important role in keeping hypertension under control. Brouwers: "Although the use of digital support in the fight against high blood pressure is very promising, more scientific research is necessary to find out how smartphone applications can be efficiently and widely implemented in the care of patients with high blood pressure."
Importance of a healthy lifestyle
Despite significant advances in the treatment of high blood pressure, Brouwers and her colleagues conclude that the saying "prevention is better than cure" continues to apply to hypertension. "We still invest too much in treating patients rather than in preventing them from becoming ill." High blood pressure, and by extension cardiovascular disease, can be prevented in many cases through various measures. A healthy lifestyle, with an explicit focus on diet, exercise and body weight, is of crucial importance here: "We also notice in our daily practice in the hypertension clinic in Aalst and Halle that patients who succeed in adopting a healthy lifestyle need much less medication to achieve an optimal blood pressure," says Brouwers.
Hypertension and Covid-19
During the pandemic, researchers also examined the influence of SARS-CoV-2 on the renin-angiotensin-aldosterone system (RAAS), which is an important determinant of blood pressure regulation. The authors conclude that, based on available scientific information, it is not appropriate to discontinue certain medications that act on the RAAS because of Covid-19. Further research on this subject is ongoing.
The article The Lancet: Brouwers, S., Sudano, I., Kokubo, Y., Sulaica, E.M. (2021), Arterial Hypertension, The Lancet - www.thelancet.com/journals/lancet/onlinefirst