Maximizing Cardiorenal Benefit in the Management of Hypertension: Achieve Blood Pressure Goals.
Current recommendations by the Sixth Report of Joint National Committee (JNC) suggest that lower blood pressure levels than previously recommended should be obtained in order to preserve renal function and reduce cardiovascular risk. This holds true for people with diabetes as well as those with renal insufficiency. By all accounts, we as a nation are doing a poor job of even achieving the general guideline for blood pressure control (i.e., less than 140/90 mm Hg). This has contributed to a plateau in mortality reduction from cardiovascular events and a may have contributed to an increase in the incidence of end stage renal disease. This paper reviews the rationale for achieving lower blood pressure goals (i.e., less than 130/85 mm Hg) in people with diabetes and/or renal disease. It also provides an approach as to how to achieve these lower goal blood pressures with a minimum of side effects. Lastly, the use of fixed dose combinations is discussed as a method to improve compliance. In brief, patients with diabetes or renal disease will require an average of 2.6-4.3 different antihypertensive medications to achieve these lower blood pressure targets. The number of medications is a function of the degree of renal insufficiency. If done appropriately, patients can consume these medications in 2 to maybe 3 pills per day. By achieving these lower blood pressure goals there is a good possibility of reducing morbidity as well as mortality from cardiovascular and renal disease. More recent reports document that it is more cost effective in these high risk groups to achieve levels of diastolic blood pressure of less than 85 mm Hg. (c)1999 by Le Jacq Communications, Inc.
Bakris
George L.
GL
Rush University-Hypertension, Department of Preventive Medicine, Rush Presbyterian-St. Luke's Medical Center, Chicago, IL.