اهمیت کنترل زود هنگام و سریع فشار خون در مدیریت فشار خون Is early and fast blood pressure control important in hypertension management?

1. Introduction Hypertension is a major cardiovascular (CV) risk factor and blood pressure (BP) lowering therapies are able to reduce the incidence of myocardial infarction, stroke, heart failure, CV and all-cause mortality [1]. These findings have been recently confirmed by a large metaanalysis conducted by Ettehad et al., including 68 randomized clinical trials performed between 1966 and 2013 [2]. In view of the impressive growth of the number of hypertensive patients (from 594 million in 1975 to 1.13 billion in 2015) [3], the detection of elevated BP is a fundamental step of any CV prevention strategy and its treatment has outstanding health benefits. Many patients, however, are still unaware of their diagnosis, are untreated or do not receive therapeutic regimens adequate to control BP within normal limits [4]. A recent analysis of data from European registries [5] has shown that on average only 39% of hypertensive patients achieve an adequate BP control. The proportion of patients reaching therapeutic targets, however, is increasing worldwide (in Italy to about 61%), though remaining unsatisfactory [6]. Multiple reasons may be advocated to explain persistent poor control of BP. Among these reasons, late or ineffective treatment, leading to irreversible or difficult to reverse adaptations of the CV system, may play a role. Thus, among the strategies which may be adopted to obtain more effective and long lasting BP reductions in hypertensive patients, one possible approach, that has been repeatedly suggested in the past, though never proved, relies on an early start of treatment and, even more, on the early achievement of BP control. In this regard, one real challenge is to unequivocally establish when to initiate the treatment, if it is worth to pharmacologically treat all grades of hypertension, and if it is possible to define a timeframe, from the initiation of the treatment to the achievement of BP control, which may eventually impact on CV outcomes. On this aspect, guidelines have so far rather elusive, whereas a position seem to be appropriate and needed. We review here the literature on the evidence of the effects of early and effective BP control in hypertension, keeping a focus also on the targets to reach. With this approach we attempt to provide physicians with the available data supporting the benefit of early BP control. We also discuss pharmacological interventions which may promote early BP reduction in hypertensives.