Where are we with the management of hypertension? From science to clinical practice.

The management of elevated blood pressure in patients at high cardiovascular risk is still a subject of debate. The authors review current international guidelines and results of large clinical trials and recent meta-analyses to discuss the different approaches in patients at high risk for cardiovascular events. The different treatment options are considered in view of the modern approach and of the different classes of drugs (diuretics, angiotensin-converting enzyme inhibitors, calcium channel blockers, beta-blockers, and angiotensin II receptor blockers) currently in use. A case report is presented as an illustration of the difficulties related to the management of high blood pressure in patients at increased risk. The benefits of the use of 2 medications that include an inhibitor of the renin-angiotensin-aldosterone system and a calcium channel blocker or a diuretic are discussed. Choosing the proper drugs and correct doses are important considerations for the long-term management of hypertension.