Update in pharmacologic treatment of hypertension.
Initial pharmacologic therapy for hypertension is low-dose thiazide diuretics, beta-blockers, and ACE inhibitors. Increasing data have confirmed that ACE inhibitors have specific benefit in patients with diabetes, atherosclerosis, left ventricular dysfunction, and renal insufficiency. CCBs are alternative agents for ISH in the elderly and appear to decrease stroke with perhaps less protection against progression of renal insufficiency and proteinuria, CAD mortality and new onset heart failure versus other initial agents, especially ACE inhibitors. ARBs are well tolerated and effective blood pressure lowering agents but have not been confirmed as effective as ACE inhibitors for reducing renal progression, clinical events, or mortality from heart failure. Effective pharmacologic antihypertensive therapy may avoid disabling and undetected cerebrovascular disease, cognitive dysfunction, and disturbing symptoms of elevated blood pressure. Vasopeptidase inhibitor, such as omapatrilat, and endothelin-1 antagonist, such as bosentan, may become future agents approved for the reduction of morbidity and mortality with hypertension. The ALLHAT trial continues to examine the potential benefits and harms of amlodipine versus chlorthalidone and lisinopril in a diverse high-risk population. Based on ALLHAT data, however, doxazosin is no longer an acceptable initial pharmacological agent. Intensive pharmacologic treatment with blood pressure lowering to less than 130/85 mm Hg is recommended with diabetes, renal insufficiency, and heart failure with additional goal of less than 125/75 mm Hg with renal failure and proteinuria greater than 1 g/24 h, based on multiple outcome studies.
Ferdinand
K C
KC
Department of Clinical Pharmacology, Xavier University College of Pharmacy, New Orleans, Louisiana, USA. kcferdmd@aol.com
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001161:Arteriosclerosis / Q000188:drug therapy; D000077300:Bosentan; D001920:Bradykinin / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D048909:Diabetes Complications; D004232:Diuretics / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D019332:Endothelin-1 / Q000037:antagonists & inhibitors; D005260:Female; D006333:Heart Failure / Q000188:drug therapy; D006801:Humans; D006973:Hypertension / Q000145:classification / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011725:Pyridines / Q000627:therapeutic use; D011788:Quality of Life; D051437:Renal Insufficiency / Q000188:drug therapy; D012084:Renin-Angiotensin System / Q000187:drug effects; D012307:Risk Factors; D013449:Sulfonamides / Q000627:therapeutic use; D013599:Systole / Q000187:drug effects; D013841:Thiazepines / Q000627:therapeutic use; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics; D019332:Endothelin-1; D011725:Pyridines; D013449:Sulfonamides; D013841:Thiazepines; C106266:omapatrilat; D000077300:Bosentan; D001920:Bradykinin