Antihypertensive strategy: a current and prospective review.
The efficacy of antihypertensive therapy in reducing cardiovascular complications has been clearly demonstrated in the last 20 years. Antihypertensives are particularly useful in the reduction of cerebrovascular complications which decrease by 60% on average in clinical trials on the treatment of mild and severe hypertension. After the first clinical trials, the 1978 World Health Organization Experts Committee recommended the classic stepped-care (SC) approach with diuretics and beta blockers as first-step agents. Other antihypertensive drugs, such as reserpine, centrally acting agents and vasodilators could be used in the next steps if blood pressure control was not achieved. Both diuretics and beta blockers have been widely used and the SC regimen has contributed to the better control of arterial hypertension in the community. The SC regimen has given general practitioners easy guidelines with which to treat hypertensive patients. There are many reasons for modifying the classic SC approach. Prescription of antihypertensive drugs at high doses should be avoided and the use of new agents, such as calcium antagonists and angiotensin-converting enzyme inhibitors, is recommended. Demographic trends have brought about an increase in the aged population and, consequently, an increase in the proportion of elderly hypertensives. These patients present particular problems in long-term management, among which are a high frequency of other associated diseases and an important number of adverse effects caused by the classic antihypertensive drugs. Nevertheless, diuretics are still useful in the treatment of hypertension, either as a monotherapy regimen or in association with other drugs. New diuretics, such as indapamide, have a very interesting pharmacologic profile with considerably fewer metabolic side effects on plasma cholesterol and glucose levels.
Pardell
H
H
Department of Internal Medicine, Red Cross Hospital, Barcelona, Spain.
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004232:Diuretics / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*
D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D004232:Diuretics