Hypertension and Cardiovascular Risk: The Importance of a Global Approach to Risk Management in the Light of Current Hypertension Guidelines

Arterial hypertension is an hard cardiovascular risk factor, being responsible for an high occurrence of cardiovascular adverse events such as myocardial infarction, stroke and congestive heart failure. However, hypertension rarely is the only contributor to such events since in most of cases the presence of elevated blood pressure values is associated with other conditions, particularly obesity, hypercholesterolemia, atherogenic dyslipidemia and diabetes mellitus. The presence of these conditions sensibly increases the level of risk, thus leading to an high morbidity and mortality. Indeed, most of adverse events related to hypertension are observed in patients with a mild increase of blood pressure levels suggesting that the concomitant presence of other risk factors significantly contributes to the overall risk. Moreover, it has been shown that untreated hypertension produces preclinical damages on cardiovascular system (heart, kidneys, vessels), further increasing the global risk. Indeed, left ventricular hypertrophy, microalbuminuria and vascular alterations are all independent predictors of cardiovascular morbidity and mortality. Based on these considerations, the current European hypertension guidelines are now drawing the attention to the concept of a global approach to cardiovascular risk in the management of hypertension. In fact, this strategy can lead to a better risk stratification of hypertensives based on the integrated evaluation of their risk factors, thus guiding the physicians to the choice of the most suitable therapeutic strategy to reduce the global cardiovascular risk of these patients.