Editorial [Hot topic: Controversies in Hypertension Treatment (Guest Editors: Maciej Banach, Sverre E. Kjeldsen and Krzysztof Narkiewicz)]

Reappraisal of the guidelines of the European Society of Hypertension (ESH) was published online on October 15, 2009 [1]. It was an important update which paid attention to the fact that many aspects needed to be explained [1]. The guidelines have been competently summarized in the paper by Mancia and Grassi in this issue [2]. For this special issue of Current Vascular Pharmacology (CVP), we invited very experienced hypertensiologists in order to continue the discussion on these controversial aspects. Therefore the issue was titled: “Controversies in Hypertension Treatment”. Bielecka-Dabrowa et al. [3] present the most current knowledge on the role of beta-blockers in the treatment of hypertension, where despite many available meta-analyses and new trials (favorable for beta-blockers) [4, 5], some authors still have doubts on their role in hypertension therapy [6]. Bielecka-Dabrowa et al. suggest that beta-blockers are one of the major classes of antihypertensive drugs, but they should not be preferred in individuals in whom there is a high risk of incident diabetes [3]. On the other hand, they remain drugs of crucial importance in many other clinical pictures frequently associated with hypertension, such as: atrial fibrillation, angina pectoris, post-myocardial infarction and congestive heart failure [1,3]. Older betablockers, such as atenolol and propranolol, may not be preferred as antihypertensive drugs, and newer beta-blockers, especially with vasodilatory properties, such as carvedilol and nebivolol, should be considered in hypertensive patients [3]. However, the authors emphasize that we still need large, prospective randomized hypertension trials to evaluate primary prevention of cardiovascular outcomes, using these newer beta-blockers as preferred therapy for hypertension [3, 7]. Another important problem has been addressed in the paper by Verdecchia and colleagues [8], who try to answer the question of whether we have enough data to consider hypertension therapy with the application of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) together, and if so, in which group of patients [8]. They suggest that on the basis of existing evidence, ACEIs and ARBs should not be considered as a preferred antihypertensive combination [8]. On the other hand, patients with resistant hypertension, particularly with proteinuria, may essentially benefit from dual blockade of the renin-angiotensin system (RAS) in terms of further blood pressure (BP) reduction and control of proteinuria [8, 9]. This combination, however, dictates the need for careful monitoring for adverse events including hyperkalemia and worsening kidney function [8]. The problem of hypertension therapy in elderly patients was presented in this issue by Aronow [10]. He agrees with the current recommendation of ESH [1] and confirms that on the basis of numerous double-blind, randomized, placebo-controlled trials, antihypertensive drug therapy significantly reduces the number of cardiovascular events in elderly persons, even including octogenarians [1, 10]. The therapy of hypertension is inseparably connected to compliance and therapeutic inertia [11]. This important problem was presented in detail in the review by Chrostowska and Narkiewicz [12]. The authors emphasized that hypertension remains an area of medicine where major improvements must be made, since goal blood pressure levels are achieved too rarely [12]. They suggest that patients must become better informed, doctors must prescribe more aggressive hypotensive treatment and the healthcare systems must be more supportive [12]. They have no doubts that these efforts might translate into a further worldwide reduction of hypertension-related cardiovascular morbidity and mortality [12]....