Document Detail

Practical issues in drug selection and dosing.
MedLine Citation:
PMID:  2563188     Owner:  NLM     Status:  MEDLINE    
Current guidelines recommend initiating antihypertensive therapy at a diastolic blood pressure greater than 90 mm Hg when nonpharmacologic measures have been unsuccessful. The risk of heart attack and stroke is increased regardless of whether the elevation of blood pressure is primarily systolic alone, diastolic alone, or both. In treating mild to moderate hypertension and in prevention and wellness programs in normotensive persons with a family history of the disease, the initial approach should be nonpharmacologic. Patients who remain hypertensive should proceed to drug therapy. Low-dose thiazide diuretics remain the preferred first step in elderly patients. In patients younger than age 40 years, especially those with tachycardia, a beta blocker may be used as the first step. Treatment should be initiated with less than a full dose, only proceeding to a full dose if necessary. If there is any appearance of extrasystoles, or a decrease in potassium levels to below 3.5 mEq/liter in the elderly, a potassium-sparing diuretic combination should be used. Although there is growing evidence that the effects of diuretic drugs on potassium may contribute to arrhythmias and sudden death, there is also increasing data suggesting that conserving electrolytes during diuretic therapy may obviate these ill effects.
H W Schnaper
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  The American journal of cardiology     Volume:  63     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  1989 Jan 
Date Detail:
Created Date:  1989-02-17     Completed Date:  1989-02-17     Revised Date:  2005-11-17    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  27B-31B     Citation Subset:  AIM; IM    
Department of Medicine, University of Alabama, Birmingham 35294.
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MeSH Terms
Adrenergic beta-Antagonists / therapeutic use*
Age Factors
Antihypertensive Agents / therapeutic use*
Hypertension / drug therapy*
Sodium Chloride Symporter Inhibitors / therapeutic use*
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Antihypertensive Agents; 0/Benzothiadiazines; 0/Diuretics; 0/Sodium Chloride Symporter Inhibitors

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

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