Target Hypertension - Professional

Thoughts on therapeutic choices

Martin — Sun, 17 Jun 2012 10:57:39 +0000

When treating with anti-hypertensive agents several principles can help guide therapeutic choices;

In any individual with hypertension, consideration should be given to using two or more antihypertensive agents, in half to standard doses, to achieve additive blood pressure lowering while minimizing the adverse effect profile.

Consideration of single pill, fixed dose combos as initial therapy as this has been shown to be more likely to achieve BP control in the briefiest time

Cover the entire 24hour period with long acting meds, preferably with once a day dosing to promote adherence to therapy

Dose once a day anti-hypertensives (particularly ACEis and/or ARBs) at night to help restore circadian BP patterns

Category:

Professional

Out of Office BP Monitoring

Martin — Sun, 17 Jun 2012 10:54:50 +0000

The most important component to the evaluation and treatment of hypertension is the accurate measurement of BP. Evaluation of BP in the office is limited by; small number of measurements, poor technique, the white coat effect (increase in BP in the medical environment) and the masked effect (a decrease in BP that happened in the medical environment). For these reasons there is considerable increased focus on out of office BP measurements. This includes the utilization of either home self-BP measurement or ambulatory blood pressure measurement (ABPM). Both techniques can accurately determine the presence of both white coat hypertension and masked hypertension. Increasing data suggests that out of office BP measurements by both measures give a better assessment of future cardiovascular risk than office BP. Finally the use of out of office BP monitoring has been associated with lower costs, and lower numbers of antihypertensive agents.

Category:

Professional

Which anti-hypertensive agent?

Martin — Sun, 17 Jun 2012 10:51:35 +0000

Patents at low cardiovascular risk and stage 1 hypertension can be initially treated with lifestyle modification solely. Those with manifestations of target organ damage and sustained BP >140/90 should have initiation of pharmacologic therapy after diagnosis of hypertension is confirmed. All classes of blood pressure lowering drugs have similar effects in reducing coronary heart disease and stroke for a given level of BP reduction. The Canadian Hypertension Education Program outlines specific clinical scenarios when specific anti-hypertensive classes are preferred (at least as initial therapy). These compelling indications include such clinical entities as; previous stroke (preferred use of ACEi/ARB and thiazide diuretics), left ventricular systolic dysfunction (ACEi, ARB, B-blocker and spironolactone), and CKD with proteinuria (RAS blockade – ACEi or ARBs).

Category:

Professional