Hypertension – A highly underestimated pathology

One in three Europeans (and one in three Italians) suffers from hypertension. This alarming statistic is on the rise with the general aging of the population. And yet, in Italy, 50% of people suffering from hypertension refuse check-ups and treatment.  New approaches to the problem, including Patient Support Programs, are expected to improve treatment adherence.

A silent killer

Over the last 40 years – from 1975 to 2015 – the number of people worldwide who suffer from hypertension has almost doubled, escalating to 1.13 million. As of 2016, in Italy, around 33% of adult men and 31% of adult women (SIIA – Italian Society of Hypertension) suffer from high blood pressure and almost 50% of these people ignore the problem. Lack of diagnosis is not only due to the fact that people suffering from hypertension often underestimate the problem.  It is also due to the fact that arterial hypertension acts silently, has no symptoms and slowly, but relentlessly, degenerates with serious complications and often leads to death. This is why it is known as the “silent killer”. It is not a disease in itself, but greatly increases the risk of strokes, heart attacks, kidney failure and other diseases.

High blood pressure can be diagnosed in one of three stages:

  • Stage 1: mild hypertension is 140/90 to 160/100
  • Stage 2: moderate hypertension is 160/100 to 180/110
  • Stage 3: severe hypertension is 180/110 or higher

Treating hypertension: nutritional-hygienic treatment and medicine

Depending on the stage of hypertension diagnosed, blood pressure can be reduced through simple nutritional-hygienic or pharmaceutical treatments.

Nutritional-hygienic treatment includes:

  • Increased physical activity
  • Weight loss with a low-calorie diet
  • Reduce sodium in diet

In the long-term, adopting a dietary approach positively impacts other risk factors often associated with hypertension, such as obesity, hypercholesterolemia and diabetes.

There are also many classes of blood pressure medications that interact with the body in different ways. The most important categories are:

  • diuretics
  • angiotensin II receptor blockers, hormonal mechanism that regulates artery constriction
  • calcium channel blockers, prevents calcium from entering the muscle cells of the heart and arteries
  • beta-blockers
  • alfa blockers and central agonists, that reduce the circulatory response to stimulus from the sympathetic nervous system

Diagnosis and treatment adherence: both in need of drastic improvement

Despite the success of scientific-medical research and the €200 billion spent annually in Europe on cardiovascular treatments related to hypertension, the silent killer continues to be the number one cause of death in the world. The main reason for this is lack of diagnosis and scarce or total lack of adherence to treatment. In Italy, for example, we know when anti-hypertension medications are taken because pharmacists must register prescribed medications given to patients. Administrative data in the region of Lombardy shows that about 40% of patients suffering from high blood pressure only fill one prescription, however, after diagnosis. The silent component of this pathology, as mentioned, is not the only reason for this occurrence. Other reasons include:

  • Treatment usually begins before symptoms appear, resulting in low adherence to treatment
  • Many patients mistakenly believe that once blood pressure is normalized, treatment can be suspended
  • One in two patients is over 65 and often affected by other pathologies that require the patient to take several medications simultaneously, which can lead to involuntary mistakes in how the medicine is taken
  • Little or no trust in therapeutic treatment

Strategies to improve awareness and treatment adherence

Hypertension is a fairly easy pathology to diagnose. The SIIA, for example, has made a simple instrument that calculates cardiovascular risk in just seconds and is available online. Effective awareness campaigns and free tests like the one promoted in the region of Lombardy in 2016 are also being carried out. In fact, in the last few years the percentage of people diagnosed with high blood pressure in Italy and Western countries has slightly increased. Adherence to treatment, instead, must still be greatly improved on. So, what is being done?

Simplified treatment through single-pill formulations is an excellent solution, especially for elderly patients. Further assistance is available through the use of new technologies, such as electronic devices and telemedicine, which aim at motivating patients to regularly take their medication.  Included in these new strategies are Patient Support Programs, which place patients at the center of a support network that includes house calls, emotional and practical support and training, remote support, appointment reminders and medication reminders as well as many other services. Domedica has been creating highly effective Patient Support Programs for more than ten years, as demonstrated. Thanks to these Patient Support Programs, the silent killer is slowly falling back.

© Domedica s.r.l.

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