Strategies to improve blood pressure control in Italy: from global cardiovascular risk stratification to combination therapy. Reference document 2012 of the Italian Society of Hypertension (SIIA) [Strategie per migliorare il controllo della pressione arteriosa in Italia: dalla stratificatione del rischio cardiovascolare globale alla terapia di combinazione. Documento di indirizzo 2012 della Società Italiana dell'Ipertensione Arteriosa (SIIA)]

Observational studies demonstrate that the proportion of treated hypertensive patients who attain the rec- ommended blood pressure goals (140/90 mmHg) does not exceed 30-40%. Conversely, clinical trials have con- sistently shown that effective blood pressure control within the recommended targets can be achieved in 70- 80% of treated hypertensive patients with different cardiovascular risk profile, especially when appropriate, effective and well tolerated combination therapies are used. In order to bridge the gap between current and optimal blood pressure control rates and to achieve a more effective cardiovascular prevention, the Italian Society of Hypertension has recently developed an interventional strategy that aims to approximate 70% of treated controlled patients by 2015. This ambitious goal can be realistically achieved by the appropriate use of modern aids and tools, also including the implementation of combination therapy, especially if this approach can be simplified into a single pill, now available in Italy. At present, 70-80% of hypertensive patients require combination therapies based on at least two classes of an- tihypertensive drugs to achieve the recommended blood pressure goals. It is therefore of paramount impor- tance to implement this strategy in routine clinical practice. Among the different combination therapies, the use of combination strategies based on drugs inhibiting the renin-angiotensin system, such as angiotensin receptor blockers and angiotensin-converting enzyme inhibitors, combined with diuretics and/or calcium-channel blockers, have demonstrated to significantly reduce the rates of major cardiovascular events and discontinuations from prescribed therapies, resulting in higher antihyper- tensive efficacy and better tolerability than monotherapy. The present document of the Italian Society of Hypertension aims to provide main indications for imple- menting combination therapy in the clinical management of hypertension in order to improve blood pressure control in Italy.