Cardiology pp 13-31 | Cite as

Control and Treatment of Arterial Hypertension

  • F. Gross


Control of hypertension can be interpreted in two ways. According to the WHO Technical Report “Arterial Hypertension” (1978), “the term ‘hypertension control’ includes all measures for health protection and promotion related to high blood pressure”, and “control programs” refer to public health actions aimed at hypertension control. The other meaning applies to the efficacy of therapy in the sense that high blood pressure of the patient should be kept under control. In other words, aspects of community programs of hypertension and of individual antihypertensive treatment have to be considered when we speak of hypertension control. This lecture will mainly deal with effective drug treatment of high blood pressure. However, in view of the large number of subjects who have elevated blood-pressure levels and the possible public health and economic consequences that may arise if drug therapy is generally recommended, it is advisable to discuss, at the beginning, some of the large controlled studies in which the significance of effective blood-pressure control for the community was investigated.


High Blood Pressure Arterial Hypertension Mild Hypertension Hypertension Control Plasma Lipid Concentration 


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  1. Amery, A., and De Schaepdryver, A., 1981, Antihypertensive therapy in patients above age 60. Fifth interim report of the European Working Party on High Blood Pressure in the Elderly (EWPHE). Current Concepts in Hypertension and Cardiovascular Disorders, 2:14–20.Google Scholar
  2. Anavekar, S. N., Ludbrooke, A., Louis, W. J., and Doyle, A. E., 1979, Evaluation of indapamide in the treatment of hypertension, J.Cardiovasc.Pharmacol., 1:389–394.PubMedCrossRefGoogle Scholar
  3. Andrews, G., Macmahon, S. W., Austin, A., and Byrne, D. G., 1982 Hypertension: Comparison of drug and non-drug treatments, Brit.Med.J., 284: 1523–26.CrossRefGoogle Scholar
  4. Atkinson, A. B., Lever, A. F., Brown, J. J., and Robertson, J. I. S., Combined treatment of severe intractable hypertension with Captopril and diuretic, Lancet 1980/11, 105–107.CrossRefGoogle Scholar
  5. Australian National Blood Pressure Study Management Committee, The Australian therapeutic trial in mild hypertension, Lancet 1980/1, 1261–1267.Google Scholar
  6. Bauer, G. E., and Hunyor, S. N., 1978, Mild hypertension: Is treatment worthwhile? Drugs, 15:80–86.PubMedCrossRefGoogle Scholar
  7. Bolli, P., Amann, F. W., and Bühler, F. R., 1980, Antihypertensive response to postsynaptic a-blockade with prazosin in low- and normal-renin hypertension, J.Cardiovasc.Pharmacol., 2:Suppl.3, 399–405.CrossRefGoogle Scholar
  8. Brogden, R. N., Heel, R. C., Speight, T. M., and Avery, G. S., 1977, Prazosin: A review of its pharmacological properties and therapeutic efficacy in hypertension, Drugs, 14:163–197.PubMedCrossRefGoogle Scholar
  9. Bühler, F. R., Laragh, J. H., Baer, L., Vaughan, E. D., Jr., and Brunner, H. R., 1972, Propranolol inhibition of renin secretion. A specific approach to diagnosis and treatment of renin-dependent hypertensive diseases, New Engl.J.Med., 287: 1209–1214.PubMedCrossRefGoogle Scholar
  10. Bühler, F. R., Hulthén, U. L., Kiowski, W., Müller, F., and Bolli, P., 1982, The place of the calcium antagonist verapamil in antihypertensive therapy, J.Cardiovasc.Pharmacol., 4:Suppl.3, in press.Google Scholar
  11. Bulpitt, C. J., Daymond, M. J., and Dollery, C. T., 1982, Community care compared with hospital outpatient care for hypertensive patients, Brit.Med.J., 284:554–556.CrossRefGoogle Scholar
  12. DeCree, J., Verhaegen, H., and Symoens, J., Acute blood pressure lowering effect of ketanserin, Lancet 1981/1, 1161–1162.CrossRefGoogle Scholar
  13. Day, J. L., Metcalfe, J., and Simpson, C. N., 1982, Adrenergic mechanisms in control of plasma lipid concentrations, Brit.Med.J., 284:1145–1148.CrossRefGoogle Scholar
  14. Fozard, J. R., The hypotensive effect of ketanserin in anaesthetized normotensive rats, Proc.Brit.Pharmacol.Soc., December 1981, Abstracts, P 63.Google Scholar
  15. Gross, F., 1982a, Present concepts and perspectives of antihypertensive therapy, Clin.Exp.Hypertension, A4:1–25.CrossRefGoogle Scholar
  16. Gross, F., 1982b, The place of a-adrenoceptor and ß-adrenoceptor blockade in the treatment of hypertension, Brit.J.Clin.Pharmacol., 13:Suppl.l, 5–11.CrossRefGoogle Scholar
  17. Helgeland, A., 1980, Treatment of mild hypertension: A five year controlled drug trial. The Oslo study, Am.J.Med., 69:725–732.PubMedCrossRefGoogle Scholar
  18. Hulthén, U. L., Bolli, P., Amann, S. W., Kiowski, W., and Bühler, F. R., 1982, Enhanced vasodilatation in essential hypertension by calcium-channel blockade with verapamil, Hypertension, 4: Suppl., 26–31.PubMedGoogle Scholar
  19. Hypertension Detection and Follow-up Program Cooperative Group, 1979, Five-year findings of the hypertension detection and follow-up program, I. Reduction in mortality of persons with high blood pressure, including mild hypertension, J.Am.Med.Assoc., 242:2562–2571.CrossRefGoogle Scholar
  20. Krebs, R., Graefe, K. -H., and Ziegler, R., 1982, Effects of calcium-entry antagonists in hypertension, Clin.Exp.Hypertension, A4:271–284.CrossRefGoogle Scholar
  21. Ledingham, J. G. G., and Rajagopalan, B., 1979, Cerebral complications in the treatment of accelerated hypertension, Quart.J.Med., (N.S.) 48:25–41.Google Scholar
  22. Leonetti, G., Pasotti, C., Ferrari, G. P., and Zanchetti, A., 1981, Double-blind comparison of the antihypertensive effects of verapamil and propranolol, in: “Calcium Antagonism in Cardiovascular Therapy.” Internat. Symp. Florence, October 1980, A. Zanchetti and D. M. Krikler, eds., Excerpta Medica, Amsterdam-Oxford-Princeton, p. 260–267.Google Scholar
  23. Leren, P., Foss, P. O., Helgeland, A., Hjermann, I., Holme, I., and Lund-Larsen, P. G., 1980, Effect of propranolol and Prazosin on blood lipids, Lancet 2:4–6.PubMedCrossRefGoogle Scholar
  24. Lowe, J., Gray, J., Henry, D. A., and Lawson, D. H., 1979, Adverse reactions to frusemide in hospital inpatients, Brit.Med.J., 2:360–362.PubMedCrossRefGoogle Scholar
  25. MacGregor, G. A., Markandu, N. D., Banks, R. A., Bayliss, J., Roulston, J. E., and Jones, J. C., 1982, Captopril in essential hypertension: contrasting effects of adding hydrochlorothiazide or propranolol, Brit.Med.J., 284:693–696.CrossRefGoogle Scholar
  26. McFate Smith, W., Edlavitch, S. A., and Krushar, W. M., 1979, U.S. Public Health Service hospitals intervention trial in mild hypertension, in: “Hypertension — Determinants, Complications and Intervention,” G. Onesti and C. R. Klimt, eds., Grune and Stratton, New York, p. 381–399.Google Scholar
  27. Morgan, T., 1976, Beta-adrenoceptor blocking drugs in the treatment of hypertension, Australia and New Zealand Journal of Medicine, 6:612.Google Scholar
  28. Morgan, T., Adam, W. R., Hodgson, M., and Myers, J., 1979, Duration of effect of different diuretics, Medical Journal of Australia, 2:315–316.PubMedGoogle Scholar
  29. M.R.C. Working Party on Mild to Moderate Hypertension, Adverse reactions to bendrofluazide and propranolol used in the treatment of mild hypertension, Lancet 1981/11, 539–543.Google Scholar
  30. Muiesan, G., Agabiti-RoSci, E., Alicandri, C., Beschi, M., Castellano, M., Corea, L., Fariello, R., Romanelli, G., Pasini, C., and Platto, L., 1981, Influence of verapamil on catecholamines, renin and aldosterone in essential hypertensive patients, in: “Calcium Antagonism in Cardiovascular Therapy,” Internat. Symp. Florence, October 1980, A. Zanchetti and D. M. Krikler, eds., Excerpta Medica, Amsterdam-Oxford-Princeton, p. 238–249.Google Scholar
  31. Van Nueten, J. M., Janssen, P. A. J., Van Beek, J., Xhonneur, R., Verbeuren, T. J., and Vanhoutte, P. M., 1981, Vascular effects of R 41.468, a novel antagonist of 5-HT serotonergic receptors, J.Pharmacol.Exp.Ther., 218:217–230.PubMedGoogle Scholar
  32. Passeron, J., Pauly, N., and Desprat, J., 1981, International multi-center study of indapamide in the treatment of essential arterial hypertension, Postgrad.Med.J., 57:Suppl,2, 57–59.PubMedCrossRefGoogle Scholar
  33. Patel, C., 1975a, Yoga and biofeedback in the management of ‘stress’ in hypertensive patients, Clin.Sci.Mol.Med., 48:Suppl.2, 171–174.Google Scholar
  34. Patel, C., 12-month follow-up of yoga and bio-feedback in the management of hypertension, Lancet 1975b/l, 62–65.CrossRefGoogle Scholar
  35. Prichard, B. N. C., and Richards, D. A., 1982, Comparison of labetalol with other anti-hypertensive drugs, Brit,J.Clin.Pharmacol., 13:Suppl.l, 41–47.CrossRefGoogle Scholar
  36. Report on Round Table, 1975, On renin suppression and the hypotensive action of beta-adrenergic-blocking drugs, Clin.Sci.Mol.Med., 48:Suppl.2, 109–115.Google Scholar
  37. Report of a WHO Expert Committee, 1978, Arterial Hypertension, Technical Report Series No.628, World Health Organization, Geneva.Google Scholar
  38. Report by the Management Committee of the Australian Therapeutic Trial in Mild Hypertension, Untreated mild hypertension, Lancet 1982/1, 185–191.Google Scholar
  39. Rose, G., 1981, Strategy of prevention: lessons from cardiovascular disease, Brit.Med.J., 282:1847–1851.CrossRefGoogle Scholar
  40. Swales, J. D., Bing, R. F., Heagerty, A., Pohl, J. E. F., Russell, G. I., and Thurston, H., Treatment of refractory hypertension, Lancet 1982/1, 894–896.PubMedCrossRefGoogle Scholar
  41. Tenschert, W., Studer, A., Záruba, K., Reuteler, H., Siebenschein, R., Siegenthaler, W., and Vetter, W., 1980, Minoxidil in hypertension, in: “Symposium: Clinical Pharmacology of Antihypertensive Agents.” K. H. Rahn and H. A. J. Struyker-Boudier, eds., Arch. Int. Pharmacodyn. Ther., p.104–115.Google Scholar
  42. Turner, P., Volans, N. G., and Rogers, H. J., 1977, Initial controlled evaluation of antihypertensive drugs: a study with indapamid, Curr.Med.Res.Opin., 5:Suppl.l, 124–128.CrossRefGoogle Scholar
  43. Veterans Administration Cooperative Study Group on Antihypertensive Agents, 1967, Effects of treatment on morbidity in hypertension: Results in patients with diastolic blood pressures averaging 115 through 129 mm Hg, J.Am.Med.Assoc., 202:1028–1034.CrossRefGoogle Scholar
  44. Veterans Administration Cooperative Study Group on Antihypertensive Agents, 1970, Effects of treatment on morbidity in hypertension II, Results in patients with diastolic blood pressure averaging 90 through 114 mm Hg, J.Am.Med.Assoc., 213:1143–1152.CrossRefGoogle Scholar
  45. Waal-Manning, H. J., 1976, Hypertension: Which beta-blocker? Drugs 12:412–441.PubMedCrossRefGoogle Scholar
  46. Wenting, G. J., Manin’t Veld, A. J., Woittiez, A. J., Boomsma, F., Schalekamp, M. A. D. H., 1982, Treatment of hypertension with ketanserin, a new selective 5-HÏ2 receptor antagonist, Clin. Res., 284:537–539.Google Scholar
  47. Wheeley, M. St. G., Bolton, J. C., and Campbell, D. B., 1982, Indapamide in hypertension: a study in general practice of new or previously poorly controlled patients, Pharmathera-peutica 2:143–152.Google Scholar
  48. White, N. J., Yahaya, H., Rajagopalan, B., and Ledingham, J. G. G., Captopril and frusemide in severe drug-resistant hypertension, Lancet 1980/11, 108–110.CrossRefGoogle Scholar
  49. Withworth, J. A., and Kiticaid-Smith, P., 1982, Diuretics or 3-blockers first for hypertension? Drugs 23:394–402.CrossRefGoogle Scholar
  50. W.H.O./I.S.H. Mild Hypertension Liaison Committee, Trials of the treatment of mild hypertension, An Interim Analysis, Lancet 1982/1, 149–156.Google Scholar

Copyright information

© Springer Science+Business Media New York 1984

Authors and Affiliations

  • F. Gross
    • 1
  1. 1.Department of PharmacologyUniversity of HeidelbergHeidelbergGermany

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