What do international guidelines say about therapy?
OBJECTIVE
We will discuss the treatment guidelines from the British Hypertension Society, Canadian Medical Association, Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, the sixth report, and the World Health Organization-International Society of Hypertension. Our emphasis will be on blood pressure thresholds, goals of therapy, non-pharmacologic interventions, choice of first-line agents in uncomplicated patients, individualized therapeutic choices, adjunctive therapy, and future considerations.


METHODS
Specific recommendations in international guidelines regarding antihypertensive therapy, that are written in English, easily accessible (i.e., found on the World Wide Web), and current (published in 1997 or later).


CONCLUSIONS
The reviewed hypertension guidelines strongly favor lifestyle modifications in all patients diagnosed with hypertension, and a trial of lifestyle modification for a specified time period prior to initiating drug therapy is advocated. Pharmacologic therapy should be based on the patient profile: presence of major cardiovascular risk factors, cardiovascular disease, target-organ damage, and concomitant medical conditions, thus allowing for the tailoring of antihypertensive therapy to the individual patient. Thiazide diuretics are the most commonly recommended antihypertensive drug class, based on numerous outcome trials. Finally, new strategies such as low-dose combination therapy are recommended as initial treatment in some patients.
Thakkar
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RB
Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, 35294, USA. rthakkar15@yahoo.com
Oparil
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D000959:Antihypertensive Agents / Q000592:standards / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D003324:Coronary Artery Disease / Q000150:complications / Q000188:drug therapy; D005060:Europe / Q000453:epidemiology; D005544:Forecasting; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D012307:Risk Factors; D012684:Sensory Thresholds / Q000187:drug effects / Q000502:physiology; D014481:United States / Q000453:epidemiology
D000959:Antihypertensive Agents