Hypertension management in patients with cardiovascular comorbidities

Abstract Arterial hypertension is a leading cause of death globally. Due to ageing, the rising incidence of obesity, and socioeconomic and environmental changes, its incidence increases worldwide. Hypertension commonly coexists with Type 2 diabetes, obesity, dyslipidaemia, sedentary lifestyle, and smoking leading to risk amplification. Blood pressure lowering by lifestyle modifications and antihypertensive drugs reduce cardiovascular (CV) morbidity and mortality. Guidelines recommend dual- and triple-combination therapies using renin–angiotensin system blockers, calcium channel blockers, and/or a diuretic. Comorbidities often complicate management. New drugs such as angiotensin receptor-neprilysin inhibitors, sodium–glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and non-steroidal mineralocorticoid receptor antagonists improve CV and renal outcomes. Catheter-based renal denervation could offer an alternative treatment option in comorbid hypertension associated with increased sympathetic nerve activity. This review summarises the latest clinical evidence for managing hypertension with CV comorbidities. Graphical Abstract Graphical Abstract Dependent on comorbidities, some medications should be preferred while others are contraindicated. Catheter-based renal denervation is under investigation (indicated by the magnifying glass) for patients with hypertension and comorbidities associated with increased sympathetic nervous system activity. *Combination of beta-blockers with non-dihydropyridine calcium channel blockers (e.g. verapamil or diltiazem) is not recommended due to a potential risk of heart block or bradycardia. ACEi, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; ARNI, angiotensin receptor-neprilysin inhibitor; BB, beta-blocker; CCB, calcium channel blocker; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; DHP, dihydropyridine; GLP1-RA, glucagon-like peptide 1 receptor agonist; HF, heart failure; MRA, mineralocorticoid receptor antagonist; RDN, renal denervation; SGLT2i, sodium–glucose cotransporter 2 inhibitor; TIA, transient ischaemic attack. Audio Abstract 10.1093/eurheartj/ehac395_audio1 Audio Abstract ehac395media1 6315097178112