Hypertension and Heart Disease:
values are ‘out of control’ for too many Italians
Vilnius, 30 May 2016 – A trip to Vilnius, Lithuania, for the Fondazione Internazionale Menarini, promoter of the ‘Breaking the Cardiovascular Continuum through Understanding, Recognition, Treatment and Prevention of the Disease’ International Congress organised by the Lithuanian University of Health Sciences, the School of Medicine of the University of Vilnius, the Lithuanian Society of Cardiology and the Lithuanian Hypertension Society. The meeting brought together various speakers, all prestigious names of acknowledged competence in the field of cardiovascular medicine including researcher and Nobel Laureate Louis Ignarro of Los Angeles, who opened the proceedings with a report to the plenary meeting on the properties of nitric oxide: it was his studies of this compound, a basic ingredient in many medicinal products, which won him the Nobel Prize in Medicine. ‘The first significant biological action observed was that nitroglycerine acts by relaxing the smooth musculature and freeing nitric oxide. Thanks to its properties, nitric oxide can be used to develop treatments to combat hypertension, arteriosclerosis, stroke, angina pectoris, heart failure, vascular complications of diabetes and other cardiovascular problems. What’s more, it was from these biological bases that researcher set out to develop medicinal products for combating erectile dysfunction.’
Another core subject at the meeting is hypertension, its prevalence and above all the lack of adequate control of the condition. ‘In both men and women, from age sixty onward, arterial hypertension is the principal cause of stroke, heart attack, cardiac insufficiency and kidney failure,’ explains Giuseppe Mancia, Professor Emeritus at the University of Milano-Bicocca. ‘We note an enormous paradox if we think that despite the many medicinal products available for treating hypertension, arterial blood pressure values are within normal limits in only 20% of patients at the time of normal check-ups. A paradox attributable above all to patients’ general failure to follow the treatment regime prescribed by their physicians.
Agabiti Rosei, Chairman of the Department of Clinical and Experimental Sciences of the University of Brescia, confirms: ‘Today, we know how important it is to continually monitor blood pressure for correct diagnosis and for prescribing the most efficacious treatments, and how critical but unfortunately and frequently underestimated is the organ damage (to the heart and other organs) that accompanies high blood pressure.’ He adds, ‘Those who treat hypertension must also take care to consider and manage the overall cardiovascular risk for each single patient, taking into account the risk factors often associated with the condition (from overweight to high cholesterol; from diabetes to smoking). What’s more, treatment is more difficult than we generally believe, as is shown by the fact that blood pressure levels are not kept under sufficient control in the majority of hypertension sufferers.’
One interesting aspect of hypertension is the fact that there are treatment-resistant forms; that is, cases in which blood pressure remains high despite treatment with three or more medicinal products belonging to different classes. What is most worrying is the extent of the phenomenon: in Europe alone, an estimated 10 to 15 million people are high-risk subjects due to high blood pressure. ‘In Italy alone, 45-50% of the general adult population suffers from arterial hypertension. This translates to more than 14 million subjects, equally distributed among the male and female populations. Of these, 5-7% ca. is affected by drug-resistant hypertension,’ warns Massimo Volpe, President of the Italian Society of Arterial Hypertension. ‘Uncontrolled arterial hypertension is a significant issue for our public health system: patients in treatment whose arterial blood pressure levels are out of control run a risk of developing cardiovascular complications (heart attack, stroke, heart or kidney failure), which can result in death, comparable to the risk run by untreated hypertensive subjects.’
Speaking of post-infarction treatment, Claudio Borghi, Professor of Internal Medicine at the University of Bologna, commented on the findings of a recent study of ACE inhibitors, medicinal products which in the last twenty years have notably lowered mortality and hospitalisation due to cardiovascular disease. ‘Retrospective analysis of the SMILE-4 study suggests that zofenopril is more efficacious than ramipril in terms of reducing hospitalisation due to cardiovascular causes in post-infarction patients with ventricular ejection fractions in excess of 40%, in the presence of concomitant therapy with acetylsalicylic acid,’ explains Borghi. ‘These data support the idea that treatment with ACE inhibitors can be useful in post-infarction patients even in the absence of signs of cardiac insufficiency.’