Summary of the Second Congress of the Serbian Society of Hypertension
and the First Symposium of the Serbian Society of Hypertension and Croatian
Society of Hypertension

 

The Second Congress of the Serbian Society of Hypertension and the First Symposium of the Serbian Society of Hypertension and Croatian Society of Hypertension were held on February 26-28th 2010 in Belgrade, Serbia. Around 820 physicians from seven countries in the region took part on the Congress. In summary:

  • - 75 lecturers were from Serbia;
  • - 24 lecturers came from abroad;
  • - 81 lectures were invited; 28 oral and 55 poster presentations were held;
  • - Participants were specialists of Internal Medicine, Cardiology, Nephrology, Endocrinology, Vascular Surgery, Pediatrics, Psychiatry, Neurology, General and Preventive Medicine

 

Conclusions:

1. Considering a lack of relevant epidemiological data on the prevalence of arterial hypertension in Serbia, a principal task of the Serbian Society of Hypertension is to undertake a systematic epidemiological research on the prevalence of arterial hypertension in the population.

2. All regional countries should be associated into a Balkan Society, considering their related geographical aspects and similar lifestyle habits of the populations of this region.

3. Having our practical experiences in mind, especially the difficulties in the classification of the patients according to numerical values of blood pressure and difficulties in making a decision about the treatment of arterial hypertension, the Society has suggested a novel classification of increased blood pressure, which could be applied together with existing ones.

 

Classification of arterial hypertension according to blood pressure level and target organ damage

Group A – Patients with increased blood pressure without target organ damage (subclinical and clinical manifested organ damage)
Group B – Patients with increased blood pressure and subclinical target organ damage, without clinically manifested organ damage
Group C – Patients with increased blood pressure and clinically manifested organ damage

4. The importance of preventive measures in the correction of lifestyle habits causing arterial hypertension (smoking cessation, stress reduction, decrease of salt intake and increase of physical activity) cannot be underestimated. Environmental and occupational risk factors (noise exposure, air pollution, occupational stress, non-physiological working conditions) were markedly highlighted. In addition, the non-pharmacological measures are of great importance in the treatment of arterial hypertension.

- The Society should initiate a social action to eliminate the influence of hazardous environmental factors (air pollution and noise exposure) causing increased blood pressure;
- A national program to limit nutritive sodium intake must be established;
- Children older than four should have their blood pressure measured at least once a year, preferably by ambulatory blood pressure monitoring;
- Future guidelines for treatment of arterial hypertension should oblige physicians to advise patients how to improve their lifestyle habits – to cease smoking, decrease sodium intake and increase physical activity;
- In newly diagnosed I grade hypertensions without other cardiovascular risk factors or target organ damage, the treatment should begin with non-pharmacological measures – correction of body weight, decrease of salt intake, smoking cessation, increase of physical activity level;
- Physicians should insist on the continuance of these non-pharmacological measures during pharmacological treatment of arterial hypertension.

 

5. In order to establish subclinical target organ damage (particularly changes on blood vessels) standard procedures should include methods for arterial stiffness and pulse wave velocity assessment. Common protocols for follow-up of hypertensive patients must be established in collaboration with other countries in the region.

6. Considering a lack of generally accepted values of optimal blood pressure in patients with peripheral arterial disease, a special approach to the treatment of hypertension in this patient group was proposed.

- Treatment of arterial hypertension in patients with peripheral arterial disease decreases cardiovascular morbidity and mortality.
- The “ideal” blood pressure values in patients with peripheral arterial disease should be defined.
- The best antihypertensive results are obtained by the use of calcium channel blockers, dihydropirins, ACE inhibitors and AT blockers.
- In cases of dissection of aorta use of nitroglycerin infusions for blood pressure treatment must be avoided.
- In patients with carotid arterial disease a rapid “normalization” of high blood pressure could lead to dangerous consequences. For this reason, systolic blood pressure should be maintained at a level that is for 10-15% higher than their basic preoperative value.
- In patients with intermittent claudications the antihypertensive therapy (the use of beta-blockers) should not be questioned by the symptoms and the function of renal arteries should be examined.
- In patients with critical ischemia of the extremities the extreme decrease of blood pressure leads to increase of pain at rest and delays the healing of ischemic ulcerations. A reasonable use of beta-blockers is advised. Avoid aggressive therapy before surgical treatment.

7. The importance of noninvasive diagnostic procedures was elaborated. Thoracic bioelectrical impedance using impedance cardiography for assessment of haemodynamic parameters with integrated “beat-to-beat” blood pressure measurement (finger pletismography) and oscillometric blood pressure measurement with ECG control and oxygen saturation level enables us to:
- Make the diagnosis of arterial hypertension on time, and to determine the type of hypertension (white-coat hypertension, masked hypertension, orthostatic hypertension, dysfunction of the autonomous nervous system, syncope);
- Choose adequate therapy and to regulate arterial blood pressure better;
- Diagnose the dysfunction of the autonomous nervous system in patients with diabetes.

8. The Society has also suggested the foundation of a regional Center for the diagnostics, research and treatment of blood pressure disorders, a highly specialized multidisciplinary service that would employ leading specialists (cardiologists, endocrinologists, nephrologists, neurologists, clinical pharmacologists, psychiatrists, specialists in nutrition, vascular surgeons) and which would be equipped with up-to-date medical equipment.

Dragan Lovic , MD , FESC
President of Serbian Society of Hypertension
 
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