[New tendencies in combination antihypertensive therapy].
In the management of hypertension, the constant lowering of target pressures ever more frequently requires combination treatment in order to achieve the goals set. A combination of amlodipine and perindopril effectively lowered the blood pressure, and significantly reduced overall mortality, cardiovascular mortality, cardiovascular events and stroke risk in comparison with atenolol/bendroflumethiazide. In combination with both ACE inhibitors and AT1 blockers, diuretics reduced blood pressure more effectively that the respective components used alone. Now, however, the long-term use of diuretics is suspected of increasing the risk of terminal kidney failure and diabetes. This also means an enhanced probability of a cardiovascular event. In the ASCOT study, the combination of beta blocker and diuretic proved inferior to treatment with a calcium antagonist and ACE inhibitor. For the long-term application of diuretics as antihypertensive monotherapy, therefore, further comparative studies involving the latest antihypertensives are mandatory.
van der Giet
M
M
Medizinische Klinik IV, Campus Benjamin Franklin, Charité, Hindenburgdamm 30 D-12200 Berlin. markus.vandergiet@charite.de
Paul
M
M
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003924:Diabetes Mellitus, Type 2 / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control; D004232:Diuretics / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D007676:Kidney Failure, Chronic / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control; D012307:Risk Factors; D013223:Statistics as Topic; D020521:Stroke / Q000401:mortality / Q000517:prevention & control
D000959:Antihypertensive Agents; D004232:Diuretics