Advertisement

Guidelines for Antihypertensive Treatment: The Debate on the Choice of Antihypertensive Drugs

  • A. Salvetti
  • L. Ghiadoni
  • G. Salvetti
Conference paper

Conclusions

Available data from controlled clinical trials comparing different drug classes seem to indicate a similar benefit in preventing cardiovascular morbidity and mortality in hypertensive patients. Although some differences in secondary end-points were detected, the overall benefit of various antihypertensive regimens seems to be linked to the extent of BP reduction. The cost of antihypertensive drugs (cost minimisation) is not an overwhelming consideration until cost-benefit analyses are correctly performed. Moreover, although the cost of drugs should be taken into account both for individual patients and for the health provider, cost considerations should not predominate over those of efficacy and tolerability in individual patients.

We therefore believe that liberality of choice among various antihypertensive drugs could offer an appropriate possibility of selecting the right drug for the right patient in order to achieve BP control, a goal which often requires rational combinations of antihypertensive drugs.

Keywords

Antihypertensive Drug Multiple Risk Factor Intervention Trial Prevent Heart Attack Trial Achieve Blood Pressure Control Achieve Goal Blood Pressure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Chobanian AV, Bakris GL, Black HR et al (2003) The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 289:2560–2571PubMedCrossRefGoogle Scholar
  2. 2.
    European Society of Hypertension-European Society of Cardiology Guidelines Committee (2003) 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension. J Hypertens 21:1011–1053Google Scholar
  3. 3.
    Whitworth JA, World Health Organization, International Society of Hypertension Writing Group (2003) World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens 21:1983–1992PubMedGoogle Scholar
  4. 4.
    Anonymous (2000) Major cardiovascular events in hypertensive patients randomized to doxazosin vs chlorthalidone: the antihypertensive and lipid-lowering treatment to prevent heart attack trial (ALLHAT) ALLHAT Collaborative Research Group. JAMA 283:1967–1975CrossRefGoogle Scholar
  5. 5.
    Anonymous (2002) Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) ALLHAT Collaborative Research Group. JAMA 288:2981–2997CrossRefGoogle Scholar
  6. 6.
    Collins R, Peto R, MacMahon S et al (1990) Blood pressure, stroke, and coronary heart disease. Part 2: Short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet 335:827–838PubMedCrossRefGoogle Scholar
  7. 7.
    Turnbull F (2003) Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively designed overviews of randomised trials. Lancet 362:1527–1535PubMedCrossRefGoogle Scholar
  8. 8.
    Dahlof B, Devereux RB, Kjeldsen SE et al (2002) Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 359:995–1003PubMedCrossRefGoogle Scholar
  9. 9.
    Wing LM, Reid CM, Ryan P et al (2003) A comparison of outcomes with angiotensin-converting enzyme inhibitors and diuretics for hypertension in the elderly. N Engl J Med 348:583–592PubMedCrossRefGoogle Scholar
  10. 10.
    Jones DW, Hall JE (2004) Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and evidence from new hypertension trials. Hypertension 43:1–3PubMedCrossRefGoogle Scholar
  11. 11.
    Salvetti A, Ghiadoni L (2004) Guidelines for antihypertensive treatment: an update after the ALLHAT study. J Am Soc Nephrol 15:S51–S54PubMedCrossRefGoogle Scholar
  12. 12.
    Ferdinand KC (2003) Recommendations for the management of special populations: racial and ethnic populations. Am J Hypertens 16:S50–S54CrossRefGoogle Scholar
  13. 13.
    Weber MA, Julius S, Kjeldsen SE et al (2004) Blood pressure dependent and independent effects of antihypertensive treatment on clinical events in the VALUE Trial. Lancet 363:2049–2051PubMedCrossRefGoogle Scholar
  14. 14.
    Psaty BM, Lumley T, Furberg CD et al (2003) Health outcomes associated with various antihypertensive therapies used as first-line agents: a network meta-analysis. JAMA 289:2534–2544PubMedCrossRefGoogle Scholar
  15. 15.
    Weber MA (2004) New results and analyses expand and modify key interpretations of the ALLHAT Trial. Rev Cardiovasc Med 5:164–169Google Scholar
  16. 16.
    Julius S, Kjeldsen SE, Weber M et al (2004) Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial. Lancet 363:2022–2031PubMedCrossRefGoogle Scholar
  17. 17.
    Angeli F, Verdecchia P, Reboldi GP et al (2004) Calcium channel blockade to prevent stroke in hypertension: a meta-analysis of 13 studies with 103,793 subjects. Am J Hypertens 17:817–822PubMedGoogle Scholar
  18. 18.
    Staessen JA, Wang JG, Thijs L (2003) Cardiovascular prevention and blood pressure reduction: a quantitative overview updated until 1 March 2003. J Hypertens 21:1055–1076PubMedCrossRefGoogle Scholar
  19. 19.
    Psaty BM, Smith NL, Siscovick DS et al (1997) Health outcomes associated with antihypertensive therapies used as first-line agents. A systematic review and meta-analysis. JAMA 277:739–745PubMedCrossRefGoogle Scholar
  20. 20.
    Anonymous (1991) 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) SHEP Cooperative Research Group. JAMA 265:3255–3264CrossRefGoogle Scholar
  21. 21.
    Davis BR, Furberg CD, Wright JT Jr et al (2004) ALLHAT: setting the record straight. Ann Intern Med 141:39–46PubMedGoogle Scholar
  22. 22.
    Anonymous (1990) Mortality after 10 1/2 years for hypertensive participants in the Multiple Risk Factor Intervention Trial. Circulation 82:1616–1628Google Scholar
  23. 23.
    Psaty BM, Lumley T, Furberg CD (2004) Meta-analysis of health outcomes of chlorthalidone-based vs nonchlorthalidone-based low-dose diuretic therapies. JAMA 292:43–44PubMedCrossRefGoogle Scholar
  24. 24.
    Franse LV, Pahor M, Di Bari M et al (2000) Hypokalemia associated with diuretic use and cardiovascular events in the Systolic Hypertension in the Elderly Program. Hypertension 35:1025–1030PubMedGoogle Scholar
  25. 25.
    Verdecchia P, Reboldi G, Angeli F et al (2004) Adverse prognostic significance of new diabetes in treated hypertensive subjects. Hypertension 43:963–969PubMedCrossRefGoogle Scholar
  26. 26.
    Klingbeil AU, Schneider M, Martus P (2003) A meta-analysis of the effects of treatment on left ventricular mass in essential hypertension. Am J Med 115:41–46PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2005

Authors and Affiliations

  • A. Salvetti
    • 1
  • L. Ghiadoni
    • 1
  • G. Salvetti
    • 1
  1. 1.Department of Internal MedicineUniversity of PisaPisaItaly

Personalised recommendations