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2012 Consensus Document of the Italian Society of Hypertension (SIIA): Strategies to Improve Blood Pressure Control in Italy

From Global Cardiovascular Risk Stratification to Combination Therapy

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Abstract

Observational clinical studies have demonstrated that only 30–40 % of patients with arterial hypertension achieve the recommended blood pressure goals (below 140/90 mmHg). In contrast, interventional trials consistently showed that it is possible to achieve effective blood pressure targets in about 70 % of treated hypertensive patients with different cardiovascular risk profiles, especially through the use of rational, effective and well tolerated combination therapies. In order to bridge the gap between current and desired blood pressure control and to achieve more effective prevention of cardiovascular diseases, the Italian Society of Hypertension (SIIA) has developed an interventional strategy aimed at reaching nearly 70 % of treated controlled hypertensive patients by 2015. This ambitious goal can be realistically achieved by a more rational use of modern tools and supports, and also through the use of combination therapy in hypertension in daily clinical practice, especially if this approach can be simplified into a single pill (fixed combination therapy), which is a therapeutic option now also available in Italy. Since about 70–80 % of treated hypertensive patients require a combination therapy based on at least two classes of drugs in order to achieve the recommended blood pressure goals, it is of key importance to implement this strategy in routine clinical practice. Amongst the various combination therapies currently available for hypertension treatment and control, the use of those strategies based on drugs that antagonize the renin-angiotensin system, such as angiotensin II type 1 receptor antagonists (angiotensin receptor blockers) and ACE inhibitors, in combination with diuretics and/or calcium channel blockers, has been shown to significantly reduce the risk of major cardiovascular events and to improve patient compliance to treatment, resulting in a greater antihypertensive efficacy and better tolerability compared with monotherapy. The present document of the Italian Society of Arterial Hypertension (SIIA) aims to gather the main indications for the implementation of combination therapy in the treatment of hypertension, in order to improve blood pressure control in Italy.

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Acknowledgments

This work has been endorsed by the Italian Society of Hypertension (SIIA). The Italian version of the document has been published in Italian language in the Giornale Italiano di Cardiologia and the Ipertensione & Prevenzione Cardiovascolare journals. The authors wish to thank Diana Chin, MD, for her help in preparing the English version of the document. There are no conflicts of interest and no sources of funding to disclose.

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Authors and Affiliations

  1. Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant’Andrea Hospital, University of Rome “Sapienza”, Via di Grottarossa 1035-39, 00189, Rome, Italy

    Massimo Volpe & Giuliano Tocci

  2. Clinical Medicine, Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy

    Enrico Agabiti Rosei

  3. Chair of Internal Medicine, University of Bologna, Bologna, Italy

    Ettore Ambrosioni & Claudio Borghi

  4. Chair of Nephrology, Department of Internal Medicine and Specialties, University of Palermo, Palermo, Italy

    Santina Cottone

  5. Department of Clinical Medicine and Prevention, Centro Ricerche Cliniche, Istituto Auxologico Italiano IRCCS, University of Milano Bicocca, Milan, Italy

    Cesare Cuspidi & Giuseppe Mancia

  6. Department of Clinical and Experimental Medicine, University of Napoli Federico II, Naples, Italy

    Nicola De Luca

  7. Department of Medicine, Clinica Medica 3, University of Padova, Padova, Italy

    Francesco Fallo

  8. Division of Internal Medicine 1, Hypertension and Cardiovascular Prevention Unit, School of Internal Medicine, San Salvatore Hospital, University of L’Aquila, L’Aquila, Italy

    Claudio Ferri

  9. Chair of Internal Medicine, Division of Internal Medicine, Hypertension Unit, San Giuseppe Hospital, Milan, Italy

    Alberto Morganti

  10. Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy

    Maria Lorenza Muiesan

  11. Division of Internal Medicine, University of Marche, Ancona, Italy

    Riccardo Sarzani

  12. Clinica Medica, Department of Clinical and Experimental Medicine, University of Udine, Udine, Italia

    Leonardo Sechi

  13. Department of Internal Medicine, University of Pisa, Pisa, Italy

    Agostino Virdis

  14. Department of Clinical Medicine, Cardiovascular and Immunological Sciences, Federico II University Hospital, Naples, Italy

    Bruno Trimarco

  15. ASL Bergamo, Bergamo, Italy

    Alessandro Filippi

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  1. Massimo Volpe
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Correspondence to Massimo Volpe.

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Volpe, M., Rosei, E.A., Ambrosioni, E. et al. 2012 Consensus Document of the Italian Society of Hypertension (SIIA): Strategies to Improve Blood Pressure Control in Italy. High Blood Press Cardiovasc Prev 20, 45–52 (2013). https://doi.org/10.1007/s40292-013-0007-2

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