il Prof. Giuseppe Danilo Norata of the University of Milan and Coordinator of the Cardiovascular and Metabolism Working Group of the Italian Society of Pharmacology (SIF) answers ten simple questions.
1) What is hypertension?
This is a condition in which blood pressure levels are higher than normal (usually multiple measurements >140mm Hg systolic and >80mm Hg diastolic). The higher the pressure, the greater the stress on the arterial walls and, consequently, the risk of cardiovascular disease.
2) What are the main risk factors?
The main risk factors are an unhealthy diet enriched with sodium salt, lack of physical activity and a high consumption of alcoholic beverages.
3) What pharmacological strategies are available today for the treatment of hypertension?
In addition to the importance of lifestyle, first-line treatments for hypertension involve the use of four different categories of drugs, often in combination: ACE inhibitors (ACEi), angiotensin II receptor blockers ( ARBs), calcium channel blockers and diuretics. To these pharmacological treatments, today there are also a series of strategies that place the patient at the center of attention. Thus, on the one hand, we are witnessing a growing interest in the use of simple devices – such as, for example, smart watches – to monitor pressure changes throughout the day, connected to a telemonitoring system available to the doctor; on the other hand, an attempt is made to improve patients’ adherence to therapy through single polypills containing active ingredients with synergistic mechanisms of action and which allow for a single daily administration.
4) What is the effectiveness of currently available drugs?
The guidelines for the treatment of hypertension are the result of numerous studies demonstrating a reduction in cardiovascular events in patients treated with antihypertensive drugs.
5) What are the main side effects?
Depending on the class of drugs, we can observe: dry cough, diarrhea or constipation, malaise, erection problems, nervousness, tiredness and weakness, nausea and vomiting.
6) Can hypertension be cured today, thanks to drugs?
Antihypertensive drugs do not cure hypertension, but they help control its levels so as to reduce the risk of cardiovascular events.
7) How can hypertension be prevented?
To prevent hypertension, from a young age, it is advisable to follow simple rules of conduct, including: having a healthy diet, rich in fruit, vegetables and wholemeal flour, reducing the amount of sodium salt (
8) What is the incidence of hypertension in Italy today?
The most recent data available, dating back to 2019, show a prevalence of 39% in men and 28.6% in women in the age group between 30 and 79 years.
9) What is the incidence of hypertension in young subjects, between 18 and 35 years old, in Italy?
Hypertension is growing in young people all over the world and Italy is no exception. It is important to highlight how in young people it represents an even greater problem than in adults, since in this case hypertension has more time to damage arteries and heart, predisposing to important cardiovascular events, such as heart attacks and strokes. The Italian I-Game study, launched by the Youth Group of the SIIA (Italian Society of Arterial Hypertension) in 2014 and entirely designed and developed by young researchers under 35, showed that 14% of Italians aged between 18 and 35 suffer from of isolated systolic arterial hypertension, i.e. has a maximum blood pressure value above 140 mmHg.
10) Are there any experimental therapies under study?
Among the drugs currently under development we have gene silencing approaches (siRNA) for specific angiotensin receptors (AT1AR), or for TRPC1-type calcium channels. At the same time, there is much interest in better understanding the mechanisms linked to resistant hypertension and, in particular, in evaluating the treatment of hyperaldosteronism through selective inhibitors with fewer side effects than currently used drugs. Finally, there is renewed interest in the endothelin system.