Complex multidrug antihypertensive regimens are required to achieve aggressive blood pressure targets of ≤130/80 mm Hg in diabetic patients and <125/75 mm Hg in hypertensive renal disease.
This review outlines strategies for achieving aggressive blood pressure targets using combination therapies and addresses the management of drug-resistant hypertension.
Rapidly accumulating clinical data have repeatedly demonstrated not only the critical importance of even small increases in blood pressure as a pathophysiologic factor in the development of cardiovascular disease, particularly in individuals with diabetes mellitus, but also the therapeutic necessity of more aggressive blood pressure reduction and the achievement of progressively lower blood pressure targets in reducing cardiovascular event rates. JNC VI has defined optimal blood pressure as or=140/80 mm Hg. Target blood pressures are now 1 gm/24 hours. Achieving such target pressures is increasingly difficult, particularly in diabetic patients with chronic renal disease, who require complex multidrug antihypertensive regimens. This review attempts to provide some suggestions for constructing such antihypertensive regimens, and provides considerations for the appropriate use of diuretics and the most effective drug combinations. Factors potentially contributing to drug resistant hypertension include such problems as failure to maximize drug dosing, suboptimal diuretic use, noncompliance, and possible confounding effects of such concomitant medications as nonsteroidal and anti-inflammatory drugs or decongestants. The issues underlying drug-resistant hypertension are listed, together with strategies for overcoming this problem.
Giles et al. (Thu,) conducted a review in Hypertension. Antihypertensive combination therapies was evaluated. Complex multidrug antihypertensive regimens are required to achieve aggressive blood pressure targets of ≤130/80 mm Hg in diabetic patients and <125/75 mm Hg in hypertensive renal disease.