First-line therapy for hypertension: different patients, different needs.
There is ample evidence that antihypertensive therapy prevents strokes, congestive heart failure, and other blood pressure-related complications, but most trials have failed to show a reduction in coronary events and mortality. Recently, the Systolic Hypertension in the Elderly Program (SHEP) showed a reduction in MIs and other coronary events in older patients with moderate to severe ISH. Cardiovascular mortality was also reduced and there was a trend toward a reduction in coronary events in the Swedish STOP-Hypertension Trial and the British MRC Trial in Older Patients. These studies have in common the use of diuretics and/or beta blockers. Although there are no similar long-term data with calcium channel blockers and ACE inhibitors, they will be the drugs of choice for many patients, based on individual responses and accompanying medical conditions.
Massie
B M
BM
University of California, San Francisco.
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000145:classification / Q000494:pharmacology / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality; D002985:Clinical Protocols; D002986:Clinical Trials as Topic; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005194:Family Practice; D006801:Humans; D006973:Hypertension / Q000145:classification / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D012720:Severity of Illness Index
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics