Future Management of High Blood Pressure

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Abstract
Both population (mass) strategies and targeted strategies for the management of high blood pressure are necessary. However, it has yet to be proven that reducing blood pressure by lifestyle changes in the population will confer the same cardiovascular benefit that results from lowering blood pressure by drugs. It is important to identify and correct those factors in hypertensive patients, such as obesity, smoking, elevated lipids, and diabetes, that confer high risk for an adverse cardiovascular event. It is now recognized that cardiovascular risk involves not only diet and lifestyle effects but that the structural and functional abnormalities resulting from high blood pressure are of great importance. There is a need to develop and validate new noninvasive methods for quantitating these structural and functional changes, together with assessment of endothelial dysfunction, hormonal profiling, and identification of susceptible genes so that high risk patients with hypertension can be selected for drug therapy. In the future, selection of an appropriate antihypertensive drug for an individual patient should also involve consideration of risk factors, structural changes, hormonal status, and genetic consideration. Central inhibition of peripheral sympathetic action by imidazoline receptor agonists, such as moxonidine, may lead to reversal of these structural and functional abnormalities without adverse effects on the central nervous system.

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