Treating hypertension to prevent coronary disease.
Because most patients with mild to moderate hypertension will not suffer a cardiovascular event due to elevated blood pressure, the presence of other risk factors must be assessed. Many of these are alterable with nondrug therapies, which cost little and carry no risks if applied sensibly. Drug therapies have costs, discomforts, and risks and should be used only for those at high risk or those who fail to respond adequately to nondrug therapies. When drug therapy is necessary, start with low doses and aim for a slow reduction of blood pressure, avoiding hypoperfusion and reducing as many risk factors as possible. Alpha blockers, angiotensin-converting enzyme inhibitors, and calcium-channel blockers may avoid metabolic risks associated with high-dose diuretic and beta-blocker therapy. The establishment of therapeutic goals, individualized assessment of status, and a conservative approach to treatment are the basis for optimal management of patients with hypertension.
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas 75235-8899.
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Kaplan
D000465:Algorithms; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D003327:Coronary Disease / Q000517:prevention & control*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008991:Monitoring, Physiologic; D012307:Risk Factors
D000959:Antihypertensive Agents