Underestimated Environmental Risks for People with Arterial Hypertension - A Narrative Review of Issues that National Guidelines Should Consider.

International guidelines for the management of arterial hypertension fail to consider environmental pollutants as risk factors for the development of the disease and its cardiovascular complications. The reasoning behind this may stem from the failure to acknowledge compelling evidence from research on the cardiovascular effects of environmental pollution. In this narrative review, we summarize the effects of environmental air pollution and noise on individuals with arterial hypertension. We explore how these pollutants interact with other environmental and individual risk factors and discuss why such individuals should be considered a vulnerable group. We also discuss local studies to help national authorities adjust international recommendations to better fit the local context. In summary, national recommendations for managing hypertension should encompass more than just blood pressure goals and prescribed antihypertensive medications. Clinicians should recommend evidence-based behavioral changes related to environmental issues to individuals with arterial hypertension. These changes can help people with arterial hypertension control their blood pressure; delay adverse cardiovascular outcomes; and enhance the effectiveness of antihypertensive medications during episodes of poor air quality, environmental noise exposure, exposure to extremely cold or warm weather, or any combination of these risk factors. Guidelines must be adapted to account for environmental pollution, social factors, cultural norms, patient preferences, equity concerns, patient lifestyle, the healthcare system, and the economic situation in the region.