Referral Pathway for Hypertension with High Cardiovascular Risk: A Review

Hypertension is considered as a common and powerful contributor to all the major cardiovascular diseases (CVDs), including coronary disease, stroke, peripheral artery disease, renal disease, and heart failure. Results from the Framingham study indicated that high blood pressure (BP), even within what is regarded as the non-hypertensive range, imposes an increased risk of CVD. The median BP at which cardiovascular sequelae appeared in the Framingham study was 130/80 mmHg. Epidemiological data have shown that the risk of CVD rises with increasing BP levels, starting at ≥115/75 mmHg in a strong, independent, graded, and continuous manner. Early and aggressive BP lowering is mandatory as it can contribute to long-term CV risk reduction. According to the Framingham study data, 31% of strokes occur in patients with normal or high normal hypertension. Clinical trial data suggest that antihypertensive therapies, particularly those that block the renin-angiotensin-aldosterone system (RAAS), can reduce CVD risks at least partly independently of BP lowering, although a major controversy involves this question. An optimal strategy to reduce CV risk may include lifestyle modifications, promoting adherence to early and aggressive target level achievement, appropriate drug choice, and especially global risk reduction.