Highlights the need for individualized antihypertensive therapy based on patient-specific factors such as age and comorbidities, rather than strictly adhering to first-line beta-blockers and diuretics.
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May support individualized antihypertensive selection by patient factors; leaves open need for prospective outcome trials.
Both the Joint National Committee and the British Hypertension Society recommend b-blockers and diuretics as first-line therapy in the treatment of uncomplicated hypertension. As a result, many clinicians will also prescribe these drugs in the treatment of patients with hypertension and coexistent disease (unless they are specifically contraindicated), even though they may not always be the most beneficial choice. This review aims to examine factors that should be taken into consideration when choosing appropriate antihypertensive therapy. Particular attention is given to treatment options in two special patient groups, the elderly and patients with co-morbid diabetes, as these groups have an increased risk of developing cardiovascular complications. In response to the increasing evidence base from large-scale trials, the article concludes that cardiovascular risk factors, coexisting disease, concomitant medication and age should all be taken into account when choosing antihypertensive therapy.
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P.G. McNally (2001) studied this question.
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