Hypertension management of patient with cardiometabolic comorbidities

Hypertension management of patient with cardiometabolic comorbidities: moving from a disease-centred to a patient-centred approach

There is a logarithmic relationship between blood pressure levels and the risk of major cardiovascular events and this risk is magnified in diabetic patients.

When we take a look at the hypertensive diabetic patient, compared to the evidence from studies such as Accord, Sprint; Advance reflects both renal protection, but also protection from both cardiovascular and total mortality.

In diabetic and hypertensive patients, the Advance study provides reliable evidence on the efficacy and safety of a fixed dose of perindopril, indapamide (with metabolic neutrality).

If you also have CCS; We must focus on therapies that help us achieve these goals:

Prevent cardiovascular events
Reduce symptoms of angina and exercise-induced ischemia if present
Control of blood pressure in addition to lifestyle changes and pharmacological treatments

In those patients who suffer from CCS and whose therapeutic objective is HR less than 70-80 BPM, antianginal medications (BB or CCB) are the ones with the greatest evidence in controlling HR but also reducing cardiovascular events and facilitating compliance when used in combination and in a single fixed-dose tablet, such as perindopril bisoprolol, which improves adherence and reduces angina.

We must not forget the control of risk factors to reduce cardiovascular events, achieving target LDL levels is not always easy, each case must be analyzed in particular, in some cases high doses of statins will not always be the best option because of its side effects and intolerance. The combination of statins plus ezetimibe + rosuvastatin is presented as an excellent alternative due to its advantageous presentation in a single pill and the use of doses better tolerated by patients.

In real life we have sicker patients with more than one chronic disease to whom we must reinforce the importance of adherence, identify barriers and overcome them, simplify treatments using a single combination of tablets with the best evidence and in this way prolong satisfying the lives of our patients throughout the cardiovascular continuum.