Integrated management of cardiometabolic risk in patients with hypertension and coronary artery

Abstract

Cardiovascular diseases remain the leading cause of premature morbidity and mortality worldwide, and most patients seen in internal medicine (“therapy”) settings present with clustered, mutually reinforcing risks—hypertension, dyslipidaemia, diabetes, chronic kidney disease (CKD), and established atherosclerotic cardiovascular disease. This integrative review summarizes a practical, evidence-based approach that bridges терапия + кардиология: (1) early risk stratification and accurate blood pressure measurement with prompt intensification when targets are not achieved; (2) comprehensive cardiometabolic prevention through lifestyle therapy plus pharmacologic risk reduction (lipid lowering, glucose-lowering agents with cardiovascular benefit, and kidney-protective strategies); and (3) guideline-directed management of chronic coronary disease and heart failure, emphasizing individualized therapy selection, adherence, and longitudinal monitoring. Contemporary guidance increasingly converges on a “treat-to-risk / treat-to-target” model: lowering blood pressure and LDL-cholesterol proportionate to absolute risk, prioritizing therapies with proven outcome benefits (e.g., high-intensity statins and add-on nonstatin agents when needed, SGLT2 inhibitors in appropriate diabetes/CKD/heart failure phenotypes), and coordinated follow-up to reduce events and improve quality of life. This терапевто-кардиологический framework supports consistent decision-making across outpatient and inpatient care and is designed to be implementable in routine clinical practice.