Publish in this journal
Journal Information
Vol. 72. Issue 10.
Pages 886 (October 2019)
Letter to the Editor
DOI: 10.1016/j.rec.2019.05.009
Full text access
Are There Gaps in the Evidence on the Treatment of Mild Hypertension in Patients With Low Cardiovascular Risk? Response
¿Existen lagunas en la evidencia vinculada al tratamiento de la hipertensión leve de bajo riesgo cardiovascular? Respuesta
Visits
...
Antonio Cocaa, Pilar Mazónb, Francisco Marínc,
Corresponding author
fcomarino@hotmail.com

Corresponding author:
a Unidad de Hipertensión y Riesgo Cardiovascular, Hospital Clínic (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
b Servicio de Cardiología, Hospital Universitario de Santiago de Compostela, CIBERCV, Santiago de Compostela, A Coruña, Spain
c Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, CIBERCV, Universidad de Murcia, El Palmar, Murcia, Spain
Related content
Rev Esp Cardiol. 2019;72:885-610.1016/j.rec.2019.04.012
Alberto Morales-Salinas
This item has received
...
Visits
(Daily data update)
Article information
Full Text
Bibliography
Download PDF
Statistics
Full Text
To the Editor,

We thank Alberto Morales-Salinas for his interest in our article1 on the new European guidelines for hypertension.2 We fully agree that the scientific evidence on most of the aspects concerning grade 1 hypertension and low cardiovascular risk is scarce and that this situation will probably continue because prospective placebo-controlled studies are unlikely to be performed to evaluate the effects of treatment on mid- and long-term morbidity and mortality in this type of patient. This lack of evidence affects and will continue to affect both lifestyle-related interventions and antihypertensive drug therapy. Thus, we have no other option but to continue basing our therapeutic decisions on the limited evidence available and to apply it on an individualized basis to our patients according to their clinical characteristics, a fact mentioned by Morales-Salinas and emphasized by the European guidelines.

In these times of precision, personalized, and preventive medicine, treatment initiation at early stages of the hypertensive process is the most logical approach, given that an intervention delay permits progression of hypertension and is associated with residual risk after blood pressure normalization. For patients with grade 1 hypertension and low cardiovascular risk, the recommended strategy is to lower blood pressure through lifestyle changes for a period of up to 6 months. This approach is advised because these patients’ values are very close to normal, although more than half are overweight and have a sedentary lifestyle, and because modest weight loss via a better diet and regular physical exercise can normalize blood pressure. Nonetheless, the intervention must also be personalized according to the socioeconomic characteristics of the population.

The European guidelines aim to be a general rule based on the best available evidence from controlled clinical trials and their meta-analyses. Because the patients included in these studies are often dissimilar to those seen in the clinic, we should individualize the guidelines by weighing up the pros and cons of our decisions with the patient. However, the responsibility for clinical decisions always lies with the physician treating the patient.

References
[1]
Grupo de Trabajo de la SEC para la guía ESC/ESH 2018 sobre la hipertensión arterial, revisores expertos para la guía ESC/ESH 2018 sobre la hipertensión arterial y Comité de Guías de la SEC.
Comentarios a la guía ESC/ESH 2018 sobre el diagnóstico y tratamiento de la hipertensión arterial.
Rev Esp Cardiol., 72 (2019), pp. 104-108
[2]
B. Williams, G. Mancia, W. Spiering, et al.
2018 ESC/ESH Guidelines for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH).
Eur Heart J, 39 (2018), pp. 3021-3104
Idiomas
Revista Española de Cardiología (English Edition)

Subscribe to our newsletter

Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

es en
Política de cookies Cookies policy
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.