Consultant. Vol. 48 No. 3
Systolic Hypertension: A Guide to Optimal Therapy
By STEPHANIE S. DeLOACH, MD
RAYMOND R. TOWNSEND, MD
University of Pennsylvania
| March 1, 2008
Dr DeLoach is an instructor in medicine and Dr Townsend is professor of medicine in the renal electrolyte and hypertension division of the University of Pennsylvania School of Medicine in Philadelphia.
• Thiazide diuretics are first-line therapy for uncomplicated hypertension. However, they are less effective in patients with impaired kidney function. In these patients, a loop diuretic is often used.
• Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have beneficial effects on left ventricular hypertrophy, which is an important consideration in patients with systolic hypertension.
• β-Blockers are rarely used as monotherapy for hypertension, although they are indicated following an acute myocardial infarction and for rate control of tachyarrhythmias.
• In patients with refractory hypertension, reinforce adherence to lifestyle modification and pharmacological therapies. Ask patients about ingestion of substances known to increase blood pressure. Consider screening these patients for secondary causes of hypertension.
• Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial Collaborative Research Group. Diuretic versus alpha-blocker as first step antihypertensive therapy: final results from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Hypertension. 2003;42:239-246.
• Dahlöf B, Devereux RB, Kjeldsen SE, et al. Cardiovascular morbidity and mortality in the Losartan Intervention for Endpoint Reduction in Hypertension Study (LIFE): a randomized trial against atenolol. Lancet. 2002;359:995-1003.
• Chobanian AV, Bakris GL, Black HR, et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. The JNC 7 Report. JAMA. 2003;289:2560-2572. Available at: http://www.nhlbi.nih.gov/guidelines/hypertension/jnc7full.pdf. Accessed February 13, 2008.
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