Drug treatment for hypertension
Table of contents
- Essentials
- ACE inhibitors (ACEIs) evd
- Angiotensin-receptor blockers (ARBs) evd
- Diuretics evd
- Calcium-channel blockers evd
- Beta-blockers (beta blocking agents) evd
- Aldosterone antagonists evd
- Centrally acting sympatholytic agents
- Other vasodilating drugs evd
- Combining antihypertensive drugs
- Reducing or stopping antihypertensive medication
- References
Extract
- Most patients will require a combination of drugs in order to achieve the treatment goal.
- If blood pressure (BP) is significantly elevated (> 160/100 mmHg, home measurements > 145/90), pharmacotherapy should be started using a drug combination DynaMed PlusE.
- One drug will lower BP by an average of 9/6 mmHg. A combination of two drugs lowers BP more effectively than doubling the dose of one drug.
- Lowering BP with drugs by 10/5 mmHg in patients with hypertension will reduce the incidence of stroke by 30–40% and that of severe coronary artery disease events by 16%, and reduce the risk of heart failure by about 40% in 5 years.
- The average reduction in blood pressure is similar with equivalent doses of ACE inhibitors (ACEIs), angiotensin-receptor blockers (ARBs), beta-blockers, diuretics and calcium-channel blockers, and they are all well tolerated at low doses. Treatment with these agents decreases
the incidence of cardiovascular events Hypertension treatment with ACE-inhibitors, angiotensin-receptor blockers, beta blockers, calcium channel blockers, or low dose diuretics decreases cardiovascular events.A.
- Adverse effects, particularly those of diuretics, beta-blockers and calcium-channel blockers, are more likely with higher doses.
- BP can be lowered with aldosterone antagonists, the alpha blocker prazosin and the centrally acting clonidine and moxonidine which inhibit the function of the sympathetic nervous system; however, there is no scientific evidence on their effect on cardiovascular events in patients with hypertension. The prognostic benefit of using spironolactone has been shown in patients with heart failure.
Linked evidence summaries
- Hypertension treatment with ACE-inhibitors, angiotensin-receptor blockers, beta blockers, calcium channel blockers, or low dose diuretics decreases cardiovascular events.A
- Thiazide users may have over 20% reduction of hip fracture risk.C
- Nifedipine appears to be more effective than placebo in reducing the frequency and severity of ischaemic attacks in the treatment of primary Raynaud apos;s phenomenon, but causes more adverse effects.B
- Aldosterone receptor antagonists decrease mortality and hospitalization in patients with congestive heart failure with an increased risk of hyperkalemia.A
Search terms
Acebutolol, Adrenergic beta-Antagonists, Aged, Amiloride, Amlodipine, Angiotensin II Type 1 Receptor Blockers, Angiotensin-Converting Enzyme Inhibitors, Antihypertensive Agents, Asthma, Atenolol, Betaxolol, Calcium Channel Blockers, Captopril, Cardiology, Celiprolol, Clonidine, Combined Modality Therapy, Creatinine, Diltiazem, Diuretics, Drug Therapy, Combination, Enalapril, Felodipine, Furosemide, Heart Failure, Congestive, Hydrochlorothiazide, Hypertension, I10, I15*, Indapamide, Internal medicine, Irbesartan, Isradipine, Kidney Failure, Labetalol, Lisinopril, Losartan, Metoprolol, Minoxidil, Nifedipine, Nisoldipine, Perindopril, Pharmacology, Prazosin, Ramipril, Renal Insufficiency, Thiazides, Verapamil, lercanidipine, loop diuretics, nonselective beta-blocker, superselective adrenergic beta-antagonists, sympatholytics, vasodilating drug