Medications for hypertension
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Medications for Hypertension: An Overview of Current Research
First-Line Antihypertensive Drugs: Efficacy and Safety
Thiazide Diuretics
Thiazide diuretics, particularly at low doses, are highly effective as first-line treatments for hypertension. They significantly reduce mortality, stroke, coronary heart disease (CHD), and total cardiovascular events (CVS) . High-dose thiazides also reduce stroke and CVS but do not significantly impact mortality or CHD.
ACE Inhibitors
Angiotensin-converting enzyme (ACE) inhibitors are another effective first-line option. They reduce mortality, stroke, CHD, and total CVS events . However, the evidence supporting their efficacy is of lower quality compared to thiazides.
Calcium Channel Blockers
Calcium channel blockers are effective in reducing stroke and total CVS events but do not significantly impact mortality or CHD . They are considered a viable first-line option, although the evidence is less robust than for thiazides.
Beta-Blockers
Beta-blockers reduce stroke and total CVS events but do not significantly impact mortality or CHD . They are generally considered less effective than thiazides and ACE inhibitors for first-line treatment.
Combination Therapies
Recent studies suggest that dual combination therapies, particularly at low-to-standard doses, are more effective than monotherapy in reducing systolic blood pressure (SBP) and improving blood pressure control without increasing adverse events. A novel approach using a single pill containing ultra-low-dose quadruple combination therapy has shown greater efficacy and tolerability compared to standard monotherapy.
Hypertension Management in Older Adults
Blood Pressure Targets
For adults aged 60 years or older, achieving a systolic blood pressure (SBP) target of less than 150 mm Hg is beneficial, reducing all-cause mortality, stroke, and cardiac events. Lower SBP targets (<140 mm Hg) do not show significant additional benefits in reducing mortality or major cardiovascular events.
Comorbid Conditions
When selecting blood pressure targets for older adults, clinicians must consider comorbid conditions. For instance, patients with a history of stroke or transient ischemic attack benefit from an SBP target of 130-140 mm Hg to reduce stroke recurrence.
Special Considerations: Hypertension in Pregnancy
Oral Antihypertensive Regimens
In pregnant women with severe hypertension, oral nifedipine retard, labetalol, and methyldopa are effective in reducing blood pressure to the target range. Nifedipine retard is slightly more effective than methyldopa but not significantly different from labetalol. These medications are viable options in low-resource settings where intravenous treatments may not be feasible.
Conclusion
Thiazide diuretics, ACE inhibitors, and calcium channel blockers are effective first-line treatments for hypertension, with thiazides showing the most robust evidence for reducing mortality and cardiovascular events. Combination therapies, particularly those involving low-to-standard doses, offer enhanced efficacy without increased adverse events. For older adults, achieving an SBP target of less than 150 mm Hg is generally beneficial, and special considerations are needed for those with comorbid conditions. In pregnant women, oral antihypertensives like nifedipine retard, labetalol, and methyldopa are effective and practical options.
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