Hypertension control- A global challenge.

Current estimates (1) reveal that more than a quarter of the adult world population has hypertension. An approximate one billion of people with diagnosed and undiagnosed hypertension is estimated to increase to more than 1.5 billion by 2025. The increase in hypertension prevalence will affect men as well as women in all world regions. Cardiovascular diseases now account for 30% of all deaths worldwide. Thus, with certainty, the increasing prevalence of hypertension worldwide will put further strain on the present cardiovascular pandemic. Looking back over the past century, cardiovascular disease and stroke have changed from being a minor cause of global death and disability to becoming one of the major contributors to the global burden of disease (2,3). Recent estimates by Kearney and coworkers (1) indicate that hypertension will become a greater population burden in economically developing compared with developed countries. This is because there is an ongoing epidemiological transition manifested as a decline in communicable disease and an increase in noncommunicable disease. Moreover, in the hypertensive patient population from the developing countries, the onset of cardiovascular disease is also predicted to occur at an earlier age (4). Despite the significance of hypertension with respect to overall health, control of high blood pressure in most countries is far from being optimal (5–7). In the USA, the proportion of patients achieving target blood pressure values less than 140/90 mmHg is only 34% of the hypertensive population (8). The situation is in no way better in the rest of the developed world and in the developing countries the situation is considerably worse (4). In fact, not only is hypertension treatment and followup worse, but also the medical infrastructure allowing for an early detection. Aging of the populations, urbanization and socioeconomic changes in the developing world have led to an increase in the prevalence of hypertension, with low control rates due to scarce health resources and insufficient health infrastructure. Thus prevention, detection, treatment and control of hypertension play an even more crucial role in future protection of cardiovascular disease. This scenario will be evident not only in the developed countries but also in the developing countries. In order to combat the emerging pandemic of cardiovascular disease, we need effective, welltolerated and affordable treatments. It is also evident that there is a need for educational activities for patients as well as physicians to improve compliance and adherence to therapy. In the current issue of Blood Pressure Drug Therapy Supplement, there is a focus on the clinical use and effectiveness of combination therapy in mild to moderate hypertensive patients. Koylan and coworkers (9) have studied the use of an AT1 receptor antagonist alone and in combination and Mugellini et al (10) and Agabiti Rosei et al (11) demonstrate the effective and safe use of a dihydropyridine calcium antagonist alone or with an addition of an ACE inhibitor. Furthermore, the therapeutic and safe use as well as the vascular effects of the dihydropyridines nifedipine (12) and benidipine (13) are reported in populations of Asian hypertensives. Current clinical guidelines put major emphasis not only on treatment to target blood pressures, but also on accurate stratification of absolute global risk in individual patient management. A global risk assessment in hypertensive patients taking into account the major associated cardiovascular risk factors (RF), such as smoking, hypercholesterolemia, diabetes and others, as well as associated clinical conditions (ACC) and target organ damage (TOD) is commonly used as a stratification scheme for estimating absolute risk for future cardiovascular disease (5–7). Such simple risk assessment of patients will provide the main determinant of whom, how and how much Blood Pressure. 2005; 14(Suppl 1): 4–5