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On the basis of current evidence provided by various studies, the most recent international guidelines recommend reducing blood pressure levels to below 140/90mmHg for all hypertensive patients over 18 years of age, including the elderly, when this is clinically tolerated, as a necessary measure to reduce the global cardiovascular risk, which is the fundamental objective of treatment. For high-risk hypertensives, such as patients with diabetes, patients with silent target organ damage or established clinical cardiovascular disease, levels below 130/80mmHg should be reached and maintained, with even lower levels for patients with established renal disease and proteinuria within the nephrotic range. Blood pressure control in high-risk patients should be achieved as rapidly as possible using initial strategies that include combinations of antihypertensive drugs, and also the best drugs and drug combinations with proven capacity to regress silent organ damage and to interrupt the progression of cardiovascular disease. This must be accompanied by the additional lifestyle measures and drugs necessary to control other associated cardiovascular risk factors. In clinical practice this means that, together with renin–angiotensin–aldosterone system (RAAS) blockade, often associated with calcium-channel blockade, statins and antiplatelet drugs should routinely be administered in most patients, particularly those over 55 years of age, as they provide the only possibility of global risk prevention leading to greater survival.

Developments in Strategies for Treating High-risk Hypertension