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Principles of Combination Therapy for Hypertension: What we Learn from the HOT and Other Studies— A Personal Point of View

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Abstract

With the publication of the HOT study, the desirable diastolic blood pressure in hypertensives has dropped to between 80 and 85 mmHg. To achieve such low levels requires combination therapy in the majority. Combination therapy is set to become standard practice in the management of hypertension, so that it is now appropriate to consider the principles involved.

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References

  1. HOT Study. Hansson L, Zanchetti A, et al. The Hypertension Optimal Treatment (HOT) Study. Patient characteristics: Randomization, risk profiles and early blood pressure results. Blood Pressure 1994;3:322-327.

    Google Scholar 

  2. Ogilvie R, Burgess E, Cusson R, Feldman R, Leiter L, Myers M. Report of the Canadian Hypertension Society Consensus Conference: 3. Pharmacologic treatment of essential hypertension. Can Med Assoc J 1993;149:557.

    Google Scholar 

  3. JNC VI. Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Arch Intern Med 1997;157:2413-2446.

    Google Scholar 

  4. Cranston W, Juel-Jensen B, Semmence A, Handfield Jones R, Forbes J, Mutch L. Effects of oral diuretics on raised arterial pressure. Lancet 1963;2:966-969.

    Google Scholar 

  5. SHEP Cooperative Research Group. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 1991;265:3255-3264.

    Google Scholar 

  6. TOMH Study. Neaton JD, Grimm RH, et al. Treatment of mild hypertension study (TOMH). Final results. JAMA 1993;270:713-724.

    Google Scholar 

  7. Pollare T, Lithell H, Berne C. A comparison of the effects of hydrochlorothiazide and captopril on glucose and lipid metabolism in patients with hypertension. N Engl J Med 1989; 321:868-873.

    Google Scholar 

  8. Materson BJ, Reda DJ, Cushman WC, et al. Single-drug therapy for hypertension in men. A comparison of six antihypertensive agents with placebo. N Engl J Med 1993; 328:914-921.

    Google Scholar 

  9. Carlsen J, Kober L, Torp-Pedersen C, Johansen P. Relation between dose of bendofluazide, antihypertensive effect, and adverse biochemical effects. Br Med J 1990;300:975-978.

    Google Scholar 

  10. Jounela AJ, Lilja M, Lumme J, et al. Relation between low dose of hydrochlorothiazide, antihypertensive effect and adverse effects. Blood Pressure 1994;3:231-235.

    Google Scholar 

  11. Cushman W, Nunn S, Lakshman M, Reda D, Materson B, VA Cooperative Study Group on Anithypertensive Agents. Monotherapy of hypertension: Effects of six classes of drugs and placebo on plasma lipids (abstr). Am J Hypertens 1993;6:9A.

    Google Scholar 

  12. Warram JH, Laffel LMB, Valsania P, Christlieb AR, S KA. Excess mortality associated with diuretic therapy in diabetes mellitus. Arch Intern Med 1991;151:1350-1356.

    Google Scholar 

  13. Elliot W. Glucose and cholesterol elevations from diuretic therapy: Intention to treat vs. actual on-therapy experience (abstr). Am J Hypertens 1993;6:9A.

    Google Scholar 

  14. Mclnnes G, Yeo W, Ramsay L, Moser M. Cardiotoxicity and diuretics: Much speculation-little substance. J Hypertens 1992;10:317-335.

    Google Scholar 

  15. Siscovick DS, Raghunathun TE, Psaty BM. Diuretic therapy for hypertension and the risk of primary cardiac arrest. N Eng J Med 1994;330:1852-1857.

    Google Scholar 

  16. Hoes AW, Grobbee DE, Lubsen J, Man in 't Veld AJ, van der Does E, Hofman A. Diuretics, β-blockers, and the risk for sudden cardiac death in hypertensive patients. Ann Intern Med 1995;123:481-487.

    Google Scholar 

  17. MRC, Medical Research Council Working Party on Mild Hypertension. Coronary heart disease in the Medical Research Council trial of treatment of mild hypertension. Br Heart J 1988;59:364-378.

    Google Scholar 

  18. Amery A, Brixko P, Clement D, et al. Mortality and morbidity results from the EuropeanWorking Party on High Blood Pressure in the Elderly trial. Lancet 1985;I.

  19. MRC Study. Medical Research Council trial of treatment of hypertension in older adults: Principal results. Br Med J 1992;304:405-412.

    Google Scholar 

  20. Weinmann S, Glass A, Weiss N, Psaty B, Siscovick D, White E. Use of diuretics and other antihypertensive medications in relation to the risk of renal cell cancer. Am J Epidemiol 1994;140:792-804.

    Google Scholar 

  21. Fioretto P, Frigato F, Velussi M, et al. Effects of angiotensin converting enzyme inhibitors and calcium antagonists on atrial natriuretic peptide release and action and on albumin excretion rate in hypertensive insulin-dependent diabetic patients. Am J Hypertens 1992;5:837-846.

    Google Scholar 

  22. STOP Study. Dahlöf B, Lindholm LH, et al. Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP-Hypertension). Lancet 1991;338:1281-1285.

    Google Scholar 

  23. Grassi G, Cattaneo BM, Seravalle G, et al. Effects of chronic ACE inhibition on sympathetic nerve traffic and baroreflex control of circulation in heart failure. Circulation 1997; 96:1173-1179.

    Google Scholar 

  24. Schneider M, Lerch M, Papiri M, et al. Metabolic neutrality of combined verapamil-trandolapril treatment in contrast to beta-blocker-low-dose chlorthalidone treatment in hypertensive type 2 diabetes. J Hypertens 1996;14:669-677.

    Google Scholar 

  25. HOT Study, Hansson L, Zanchetti A, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: Principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet 1998;351:1755-1748.

    Google Scholar 

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Opie, L.H. Principles of Combination Therapy for Hypertension: What we Learn from the HOT and Other Studies— A Personal Point of View. Cardiovasc Drugs Ther 12, 425–429 (1998). https://doi.org/10.1023/A:1007789629484

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  • DOI: https://doi.org/10.1023/A:1007789629484

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