The Changing Role of Hypertension Societies

Abstract

In 2012, hypertension still stands as the most diffuse and principal risk factor for cardiovascular disease worldwide. Hypertension is partially preventable, as healthy lifestyle measures, especially in Western or ‘westernized’ societies, play a key role in holding blood pressure levels within normal limits, although pharmacological support sooner or later becomes unavoidable in most patients developing hypertension. This may have relevant consequences, from both the clinical and the socioeconomic points of view. The prevention of hypertension, in fact, translates into a major healthcare benefit for both individuals and societies, in view of the reduced burden of hypertension-related cardiovascular disease and healthcare costs. Thus, in any cardiovascular preventive strategies at the individual level or at the population level, the central role of hypertension cannot be minimized or ignored, and should be, indeed, fully recognized. Once hypertension is established in an individual patient, the achievement of blood pressure targets within the normal limits (i.e. blood pressure below 140/90mmHg, or below 130/80 in hypertensive patients with diabetes mellitus or nephropathy) bringsmajor clinical advantages in terms of preventing or delaying the development of cardiovascular damage and disease, reducing incidence or recurrence of stroke, myocardial infarction and acute coronary syndromes, reducing progression towards congestive heart failure and end-stage renal disease, reducing or delaying progression of atherosclerotic damage at vascular kidney, eye and peripheral level, and reducing death. Therefore, the effective management and prevention of hypertension is definitely one of the most important healthcare targets of our time. However, the results achieved so far in terms of blood pressure control are largely unsatisfactory around the world, including Italy. Despite the doubtless progress in the pathophysiological role of hypertension and its complex syndromic nature, as well as of themajor achievements in the effectiveness, tolerability and safety of the new drugs used for the clinical management of hypertension, the general outcomes remain disappointing. Control of blood pressure in different countries ranges at best between 20% and 35%, according to the latest reports. This means that, for a number of reasons that are difficult to synthesize here, about three-quarters of hypertensive patients are not treated properly, i.e. they remain exposed at a considerably higher risk than what could be accomplished just treating them at goal. This implies complex and integrated actions, including appropriate population information, general and specific interventions on lifestyle, patient knowledge, physician commitment, physician-patient communication, choice of appropriate therapies, wider use of combination therapies (which is in the end needed in about 60% of treated hypertensive patients), and so on. The role of scientific societies is, indeed, to promote progress, knowledge and science. In the general landscape of scientific societies, hypertension societies around the world have played a growing role in this specific field, generating through committees and scientific journals authoritative, exhaustive and even pragmatic guidelines, as well as a significant progress in the knowledge and care of hypertension from the 1960s to the eve of the third millennium. Also, the clinical studies prompted in the field of hypertension represent keystones and landmark examples in modern medicine. The Italian Society of Hypertension has occupied a leading role, not only in Europe, but even worldwide, being extensively recognized by the international community, also through its founders and leaders, as one of the driving forces in the whole progressive process, that has characterized the field of hypertension over the last 50 years. As with other hypertension scientific groups or societies around the world, the Italian Society of Hypertension has EDITORIAL High Blood Press Cardiovasc Prev 2012; 19 (1): 1-2 1120-9879/12/0001-0001/$49.95/0