Document Detail


Combination therapy as first-line treatment for hypertension.
MedLine Citation:
PMID:  19178127     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Systemic hypertension is a long-term risk factor for the development of atherosclerotic vascular disease and when uncontrolled is a short-term trigger of acute vascular events such as acute coronary syndromes and stroke. Thus, rapid reduction in BP is desirable. Patients at high risk for vascular disease, such as those with diabetes mellitus, have aggressive goal BP targets because studies have shown that achieving these targets reduces events. Given the dual goals in high-risk patients of reducing BP quickly and to aggressively low targets, the classic 'step therapy' of one drug titrated at a time to reduce BP is inadequate. Combination therapy with at least two potent medications makes more sense, and manufacturers are now increasing their offerings of single-pill combinations for hypertension. Combination pills are popular with patients and increase compliance with therapy. Many believe that renin-angiotensin aldosterone system (RAAS) blockers are the cornerstone of hypertension treatment in patients at high risk for vascular disease. The newer combination pills include a RAAS blocker and diuretics or a long-acting calcium channel antagonist (CCA). Recent studies have shown that a RAAS blocker plus a dihydropyridine CCA is superior to older diuretic-based combinations for preventing cardiovascular events. These considerations support a new approach to the higher risk hypertensive patient: effective doses of RAAS blocker/CCA combination pills to rapidly lower BP to <130/80 mmHg.
Authors:
Michael H Crawford
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American journal of cardiovascular drugs : drugs, devices, and other interventions     Volume:  9     ISSN:  1175-3277     ISO Abbreviation:  Am J Cardiovasc Drugs     Publication Date:  2009  
Date Detail:
Created Date:  2009-01-30     Completed Date:  2009-06-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100967755     Medline TA:  Am J Cardiovasc Drugs     Country:  New Zealand    
Other Details:
Languages:  eng     Pagination:  1-6     Citation Subset:  IM    
Affiliation:
Division of Cardiology, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, California 94143-0124, USA. crawfordm@medicine.ucsf.edu
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MeSH Terms
Descriptor/Qualifier:
Angiotensin II Type 1 Receptor Blockers / administration & dosage,  therapeutic use*
Angiotensin-Converting Enzyme Inhibitors / administration & dosage,  therapeutic use*
Antihypertensive Agents / administration & dosage,  therapeutic use*
Blood Pressure / drug effects
Calcium Channel Blockers / administration & dosage,  therapeutic use*
Diuretics / administration & dosage,  therapeutic use*
Drug Combinations
Drug Synergism
Drug Therapy, Combination
Humans
Hypertension / drug therapy*,  physiopathology
Patient Compliance
Renin-Angiotensin System / drug effects
Chemical
Reg. No./Substance:
0/Angiotensin II Type 1 Receptor Blockers; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Antihypertensive Agents; 0/Calcium Channel Blockers; 0/Diuretics; 0/Drug Combinations

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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