Arterial Hypertension in Cardio-Renal-Metabolic Syndrome: New Targets and Proven Treatment Approaches

The article focuses on the treatment challenges of arterial hypertension (AH) in patients with cardio-renal-metabolic syndrome (CRMS). It examines the pathophysiological mechanisms of AH development in CRMS patients. Evidence is provided to highlight the critical role of metabolic risk factors in the progression of cardiovascular disease (CVD) complications. These factors include abdominal obesity, dysglycemia, atherogenic dyslipidemia, and AH, which independently affect endothelial function, atherosclerosis, thrombosis, myocardial damage, fibrosis, and cardiac remodeling, influencing the risk of almost all CVD complications, including coronary heart disease, cerebrovascular disease, peripheral artery disease, arrhythmias, and heart failure. The rationale for earlier initiation of antihypertensive therapy in CRMS patients is discussed, aiming both to reduce CVD complication risks and prevent the progression of chronic kidney disease. Scientific data are provided to support the selection of optimal antihypertensive therapy in CRMS. The evidence emphasizes the initial and maintenance therapy with a combination drug containing perindopril and indapamide has a positive effect on microvascular function in patients with AH and reduces the severity of target organ damage in CRMS. The necessity of a flexible approach to dosing such medications is highlighted to ensure both efficacy and safety, especially in vulnerable patient groups with AH.