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Hypertension is a critically important worldwide public health issue

which is understood to be the leading risk factor globally for mortality.

Dr Mel Lobo –

Consultant Physician and

Clinical Hypertension Specialist

Dr Mel Lobo is a Consultant Physician

with a special interest in Hypertension and

Hypercholesterolaemia. Dr Lobo is the Director

of the internationally renowned Barts and The

London Hypertension Clinic which has been

recognised as a Hypertension Centre of Excellence

by the European Society of Hypertension. Dr Lobo

is an accredited Clinical Hypertension Specialist of

the European Society of Hypertension (one of only

33 in the whole of the UK) and sees in excess of

2,000 hypertension-related consultations per year

in both inpatient and outpatient settings. He also

has extensive experience of treating patients with

Hypercholesterolaemia and other lipid disorders.

For appointments call

020 7791 5066

or email

[email protected]



Global Prevalence: It is alarming to note

that there are currently in excess of 970

million adults with Hypertension globally

and that this figure is projected to rise to

more than 1.5 billion worldwide by 2025.

Three quarters of the world’s hypertensive

population will then be from economically

developing countries.

The UK situation: Data from the Health

Survey for England 2006 indicates that,

over the age of 16 years, 39% of all males

and 31% of all females have Hypertension

defined as a BP ≥ 140/90mm Hg.

Shockingly, only 20% of the population

have their BP treated adequately and

controlled, meaning that the vast majority

of men and women with Hypertension

are either untreated or uncontrolled on

existing therapy.


Home BP Monitoring (HBPM) – can easily

be performed by most patients provided a

validated oscillometric monitor is used with

an appropriate sized arm cuff.The evidence

indicates that the results are somewhat

lower than office (clinic) BP values and are

a better predictor of cardiovascular (CV)

risk when multiple readings are taken.

24-hour Ambulatory BP Monitoring

(ABPM) – 24-hour ABPM is the most

sensitive predictor of CV morbidity and

mortality compared to conventional

(office) and Home BP Monitoring. ABPM

is also used to diagnose white coat

Hypertension and masked Hypertension

and to non-invasively document nocturnal

BP values.The technique is increasingly

being used as a guide to the efficacy of

anti-hypertensive therapy.


Multiple anti-hypertensive drugs

are needed

Over the past several years, it has become

increasingly clear that even in the ideal

setting of the randomised controlled

clinical trial, at least two to three anti-

hypertensive drugs are required to attain

BP targets (see Table 1 below). A strong

argument therefore exists to start patients

with significant Hypertension (Stage 2 or

greater) on a cocktail of two drugs and

that this may take the form of a fixed dose


HYVET – a landmark clinical trial

Published last year, the ‘Treatment of

Hypertension in patients 80 years

of age or older’ trial (HYVET) has

clearly demonstrated that treatment

of Hypertension in the elderly with

indapamide and/or perindopril led to

major reductions in death from stroke

and CV disease, as well as a significant

reduction in all cause mortality.There

is no longer an excuse not to treat

elderly hypertensive patients to an

optimal target of <150/80mm Hg.

Example of a

printout from

a 24-hour BP



Trial Patient

Target BP

No of Anti-hypertensive


(mm Hg)




Diastolic < 80


ALLHAT Hypertension plus at least

< 140 / 90


one other CVD risk factor

ASCOT Hypertension plus at least

< 140 / 90


three other CVD risk factors

< 130 / 80 with diabetes


Hypertension plus Type 11

< 135 / 85


Diabetes Mellitus

AASK Hypertension plus renal

Mean arterial pressure



(MAP) < 92

Table 1.

Multiple anti-


are required to

attain BP targets.



On the basis of the data recorded and the available literature, the ABPM

suggests mild daytime systolic and diastolic hypertension (147 mmHg/93

mmHg and normal night-time systolic and diastolic blood pressure (111

mmHg / 66 mmHg) with a white-coat effect (158 mmHg / 90 mmHg).