Via practica 2/2009

Treatment of hypertension – never ending story?

Author summarizes new findings in the treatment of hypertension that change the position of beta-blockers and diuretics as the first-line drugs. In introduction are given reasons to the continual effort to improve a global treatment effectiveness of high blood pressure and as well to the negative impact of new age over-weight and obesity epidemic in population on the global effectiveness of hypertension management. The related increase in incidence of metabolic syndrome and of overall cardiovascular risk has led to the change in therapeutic strategy. Beta-blockers with their negative metabolic effect are leaving the first line position in therapy and even the combination of beta-blocker and diuretics are not recommend any more, particularly in younger adults with metabolic syndrome. Different influencing of arterial wall properties, especially its stiffness and central aortic blood pressure parameters are another factors causing the changes in the strategy for treatment of hypertension. The non-invasive investigation of them is gradually becoming a standard of hypertension management and of sub clinical diagnostic of atherosclerosis. The boldest expression of the described new aspects in treatment of hypertension is the British scheme of guidelines for clinical practice that is not yet fully reflected in the European and American guidelines.

Keywords: beta-blockers and diuretics in the treatment of hypertension, therapy of hypertension coinciding with metabolic syndrome,therapy of hypertension in respect to aortic blood pressure parameters