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November 14, 2004
Hypertension

Treatment of Hypertension - What's the goal of therapy?

 

This week I've decided to talk about the ubiquitous problem of hypertension, (this is a very basic overview of hypertension, but it's interactive, so have fun.) Of course, we're all aware of the many co-morbidities associated with hypertension and the importance of treating it.  There are different approaches to treatment which we should be aware of and while separate treatments may reduce blood pressure a comparable amount, there may be differences in the long-term outcome for our patients, which is the point.

 
  • This study compares the outcomes for elderly patients with hypertension treated with Angiotensin Converting Enzyme Inhibitors (ACEIs) and those treated with diuretics.  The major conclusion to the study is that patients, particularly elderly men, treated with ACEIs have better outcomes than those treated with diuretics despite similar decreases in blood pressure.
  • This study compares ACEIs and ACE Receptor Blockers (ARBs) in reference of preventing myocardial infarction.  The authors were unable to find a difference, which is fortunate for patients who can not tolerate ACEIs.
  • As this review states, there is evidence that Ramipril (Altace) reduces the rate of mortality in patients with hypertension.  However, further studies are necessary to determine if any of the ACEIs are better than one another.
 
We are going to be treating patients with hypertension regardless of what we end up going into.  Therefore, we need to choose treatments that ensure the long-term safety of our patients, not just reduce the numbers on a scale.
Posted At : 11:04 AM. | Link | Rotation 2 04-05 | Comments (9)

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Comments

These are some great studies and are particularly useful considering the enormous number of patients out there with hypertension. I've already seen a few patients suffering from the ACE inhibitor cough, so it is good to know that switching them to an ARB will not be detrimental.

Posted By Jason Vachon / Posted At 11/14/04 2:16 PM

I also saw a patient who complaine of the "ACE cough". We are fortunate in the sense of varsatility of meds for HTN. Thanks for the info paul!

Posted By Adi Abramovici / Posted At 11/14/04 4:39 PM

great info Paul, Swanson's actually says that diuretics are the preffered long term control of hypertension in the elderely,...evidently their wrong...Thanks for the great articles.

Posted By Michael Paul / Posted At 11/14/04 5:21 PM

Thanks for tackling this huge topic Paul. Good info. I know that at least in my office, we have lots of patients on ARBs.

And to add to your post, I think the newest guidelines recommend that any diabetics be put on ACEs and statins regardless of blood pressure or cholesterol to improve mortality and prevent the development of metabolic syndrome. (see Paul's post from 11/2)

Posted By Jonathan Cahill / Posted At 11/14/04 6:52 PM

I wonder if these results break down by race. Because my preceptor was explaining that HCTZ is the drug of choice for treating African Americans with hypertension. As a result that is always the first drug she prescribes to African Americans.

Posted By Alicia Tucker / Posted At 11/14/04 11:28 PM

The wealth of information on this topic is very immense. Great job summarizing some of the key facts and highlighting some of the positives about the vesatility of the pharmaceutical therapy.

Posted By John Mastrangelo / Posted At 11/15/04 7:16 AM

Good job, Paul. As Jon mentioned, I saw a lot of diabetic patients on ACEI and statin even though they don't have htn or dyslipidemia. By the way, the htn website looks very helpful for pt education.

Posted By Nahee Lee / Posted At 11/16/04 11:10 PM

neat, I thought though that most people being treated with ACE's are also on diuretics, at least where I was, everyone was on HCTZ as well! So, from my experience I find it weird that they are comparing their separate uses.... Nice blog though.

Posted By Furkan Shinaishin / Posted At 11/18/04 12:58 PM

thanks for the info, especially the article showing that arb's and acei's are equally effective.

Posted By Rajanya Shah / Posted At 11/18/04 8:07 PM