Progress in the treatment of hypertension

Over the past five decades, we have witnessed significant developments in the management of patients with arterial hypertension and elucidation of basic mechanisms involved in the disease. Many of these progresses resulted from experimental and clinical studies conducted in Italy. Several randomized clinical trials have been carried out worldwide and in Italy according to the best available evidence-based medicine rules, often before the initiation of comparable studies in different cardiovascular areas (acute coronary syndromes, arrhythmias, heart failure). Because of these progresses, we currently dispose of a huge therapeutic armamentarium of effective and generally well tolerated antihypertensive drugs. Ablation of renal nerves is a procedure which is re-gaining attention. We are also learning how to correctly measure blood pressure not only in the hospital setting, but also during normal daily activities using 24 h ambulatory blood pressure monitoring and self-measured home blood pressure. Out-of-office blood pressure proved to be superior to office blood pressure in its relationship with hypertensive organ damage and risk of major cardiovascular complications and mortality. Currently, we should improve our understanding of out-of-office blood pressure measurements and the clinical use of several available drug combinations according to their efficacy and tolerability in the single patients. We should also learn more about optimal blood pressure targets to be achieved in the general hypertensive population is specific subgroups at different cardiovascular risk.