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Erschienen in: American Journal of Cardiovascular Drugs 2/2002

01.03.2002 | Therapy in Practice

Antihypertensive Drugs

An Overview

verfasst von: Professor C. Venkata S. Ram

Erschienen in: American Journal of Cardiovascular Drugs | Ausgabe 2/2002

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Abstract

For most patients with systemic hypertension, long-term drug treatment is indicated and is beneficial. There is overwhelming evidence to suggest that antihypertensive drugs offer protection against complications of hypertension. Whereas nondrug therapeutic options should be implemented in all patients, a vast majority will require pharmacological treatment to achieve goal blood pressure levels. Fortunately, a number of drugs are available to accomplish successful treatment of hypertensive disorders.
While it is conventional to initiate treatment with a single drug, a suitable combination of drugs is often required to control the blood pressure effectively. Although diuretics and β-blockers are effective and well tolerated, other classes of drugs are being increasingly used as the initial choice of therapy for hypertension. Every class of antihypertensive drugs offer advantages and some disadvantage; the physician should weigh the benefits and risks in selecting one drug over another. While the clinical parameters are followed in the management of patients with hypertension, it is also necessary to monitor the patients’ biochemical profile periodically in order to modify and adjust the therapy accordingly. A careful selection of drug therapy along with close follow-up offers the best prospect to reduce the burden of morbidity and mortality in hypertension. This article provides an overview of drugs in the management of patients with hypertension.
Literatur
1.
Zurück zum Zitat Joint National Committee. The sixth report of the Joint National Committee on detection, evaluation, and treatment of high blood pressure (JNC VI). Arch Intern Med 1997; 157: 2413–46CrossRef Joint National Committee. The sixth report of the Joint National Committee on detection, evaluation, and treatment of high blood pressure (JNC VI). Arch Intern Med 1997; 157: 2413–46CrossRef
2.
Zurück zum Zitat Berlowitz DR, Ash AS, Hickey EC, et al. Inadequate management of blood pressure in a hypertensive population. N Engl J Med 1998; 339: 1957–63PubMedCrossRef Berlowitz DR, Ash AS, Hickey EC, et al. Inadequate management of blood pressure in a hypertensive population. N Engl J Med 1998; 339: 1957–63PubMedCrossRef
3.
Zurück zum Zitat Agarwal R, Ram CVS. Diuretics. In: Singh BN, Dzau VJ, Vanhoute PM, editors. Cardiovascular pharmacology and therapeutics. New York: Churchill Livingstone, 1994; 319: 353–68 Agarwal R, Ram CVS. Diuretics. In: Singh BN, Dzau VJ, Vanhoute PM, editors. Cardiovascular pharmacology and therapeutics. New York: Churchill Livingstone, 1994; 319: 353–68
5.
Zurück zum Zitat LaCroix AZ, Ott SM, Ichikawa L, et al. Low-dose hydrochlorothiazide and preservation of bone mineral density in older adults. Ann Intern Med 2000; 133: 516–26PubMed LaCroix AZ, Ott SM, Ichikawa L, et al. Low-dose hydrochlorothiazide and preservation of bone mineral density in older adults. Ann Intern Med 2000; 133: 516–26PubMed
6.
Zurück zum Zitat Ram CVS, Garrett BN, Kaplan NM. Moderate sodium restriction and various diuretics in the treatment of hypertension: effects on potassium wastage and blood pressure control. Arch Intern Med 1981; 141(8): 1015–9PubMedCrossRef Ram CVS, Garrett BN, Kaplan NM. Moderate sodium restriction and various diuretics in the treatment of hypertension: effects on potassium wastage and blood pressure control. Arch Intern Med 1981; 141(8): 1015–9PubMedCrossRef
8.
Zurück zum Zitat Grossman E, Messerli FH, Goldbourt U. Does diuretic therapy increase the risk of renal cell carcinoma? Am J Cardiol 1999; 83: 1090–3PubMedCrossRef Grossman E, Messerli FH, Goldbourt U. Does diuretic therapy increase the risk of renal cell carcinoma? Am J Cardiol 1999; 83: 1090–3PubMedCrossRef
9.
Zurück zum Zitat Freemantle N, Cleland J, Young P, et al. β-blockade after myocardial infarction. BMJ 1999; 318: 1730–7PubMedCrossRef Freemantle N, Cleland J, Young P, et al. β-blockade after myocardial infarction. BMJ 1999; 318: 1730–7PubMedCrossRef
10.
Zurück zum Zitat Gottlieb SS, McCarter RJ, Vogel RA. Effect of beta-blockade on mortality among high-risk and low-risk patients after myocardial infarction. N Engl J Med 1998; 339: 489–97PubMedCrossRef Gottlieb SS, McCarter RJ, Vogel RA. Effect of beta-blockade on mortality among high-risk and low-risk patients after myocardial infarction. N Engl J Med 1998; 339: 489–97PubMedCrossRef
11.
Zurück zum Zitat Heidenreich PA, McDonald KM, Hastie T, et al. Meta-analysis of trials comparing β-blockers, calcium antagonists, and nitrates for stable angina. JAMA 1999; 281: 1927–36PubMedCrossRef Heidenreich PA, McDonald KM, Hastie T, et al. Meta-analysis of trials comparing β-blockers, calcium antagonists, and nitrates for stable angina. JAMA 1999; 281: 1927–36PubMedCrossRef
12.
Zurück zum Zitat Jamerson K, Dequattro V. The impact of ethnicity on response to antihypertensive therapy. Am J Med 1996; 101 Suppl. 3A: S22–32CrossRef Jamerson K, Dequattro V. The impact of ethnicity on response to antihypertensive therapy. Am J Med 1996; 101 Suppl. 3A: S22–32CrossRef
13.
Zurück zum Zitat Lardinois CK, Neuman SL. The effects of antihypertensive agents on serum lipids and lipoproteins. Arch Intern Med 1988; 148: 1280–8PubMedCrossRef Lardinois CK, Neuman SL. The effects of antihypertensive agents on serum lipids and lipoproteins. Arch Intern Med 1988; 148: 1280–8PubMedCrossRef
14.
Zurück zum Zitat ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major cardiovascular events in hypertensive patients randomized to doxazosin vs chlorthalidone. JAMA 2000; 283: 1967–75CrossRef ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major cardiovascular events in hypertensive patients randomized to doxazosin vs chlorthalidone. JAMA 2000; 283: 1967–75CrossRef
15.
Zurück zum Zitat Ram CVS, Anderson RJ, Hart GR, et al. Alpha-adrenergic blockade by Prazosin in therapy of essential hypertension. Clin Pharmacol Ther 1981; 29(6): 719–22PubMedCrossRef Ram CVS, Anderson RJ, Hart GR, et al. Alpha-adrenergic blockade by Prazosin in therapy of essential hypertension. Clin Pharmacol Ther 1981; 29(6): 719–22PubMedCrossRef
16.
Zurück zum Zitat Rabkin SW. Mechanisms of action of adrenergic receptor blockers on lipids during antihypertensive drug treatment. J Clin Pharmacol 1993; 33: 286–91PubMed Rabkin SW. Mechanisms of action of adrenergic receptor blockers on lipids during antihypertensive drug treatment. J Clin Pharmacol 1993; 33: 286–91PubMed
17.
Zurück zum Zitat Messerli FH. Implications of discontinuation of doxazosin arm of ALLHAT. Lancet 2000; 355: 863–4PubMedCrossRef Messerli FH. Implications of discontinuation of doxazosin arm of ALLHAT. Lancet 2000; 355: 863–4PubMedCrossRef
18.
Zurück zum Zitat Grubb BP, Sirio C, Zelis R. Intravenous labetalol in acute aortic dissection. JAMA 1987; 258: 78–9PubMedCrossRef Grubb BP, Sirio C, Zelis R. Intravenous labetalol in acute aortic dissection. JAMA 1987; 258: 78–9PubMedCrossRef
19.
Zurück zum Zitat Clark JA, Zimmerman HJ, Tanner LA. Labetalol hepatotoxicity. Ann Intern Med 1990; 113: 210–3PubMed Clark JA, Zimmerman HJ, Tanner LA. Labetalol hepatotoxicity. Ann Intern Med 1990; 113: 210–3PubMed
21.
Zurück zum Zitat Ram CVS, Holland OB, Fairchild C, et al. Withdrawal syndrome following cessation of guanabenz therapy. J Clin Pharmacol 1979; 19: 148–50PubMed Ram CVS, Holland OB, Fairchild C, et al. Withdrawal syndrome following cessation of guanabenz therapy. J Clin Pharmacol 1979; 19: 148–50PubMed
22.
Zurück zum Zitat Ram CVS, Engelman K. Abrupt discontinuation of clonidine therapy. JAMA 1979; 242(19): 2104–5PubMedCrossRef Ram CVS, Engelman K. Abrupt discontinuation of clonidine therapy. JAMA 1979; 242(19): 2104–5PubMedCrossRef
23.
Zurück zum Zitat Bhatia BB. On the use of rauwolfia serpentina in high blood pressure. J Ind Med Assoc 1942; 11: 262–5 Bhatia BB. On the use of rauwolfia serpentina in high blood pressure. J Ind Med Assoc 1942; 11: 262–5
24.
Zurück zum Zitat Brown NJ, Vaughan DE. Angiotensin-converting enzyme inhibitors. Circulation 1998; 97: 1411–20PubMedCrossRef Brown NJ, Vaughan DE. Angiotensin-converting enzyme inhibitors. Circulation 1998; 97: 1411–20PubMedCrossRef
26.
Zurück zum Zitat Heart Outcomes Prevention Evaluation (HOPE) Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000; 342: 145–53CrossRef Heart Outcomes Prevention Evaluation (HOPE) Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000; 342: 145–53CrossRef
27.
Zurück zum Zitat Saunders E, Weir MR, Kong BW, et al. A comparison of the efficacy and safety of a β-blocker, a calcium channel blocker, and a converting enzyme inhibitor in hypertensive blacks. Arch Intern Med 1990; 150: 1707–13PubMedCrossRef Saunders E, Weir MR, Kong BW, et al. A comparison of the efficacy and safety of a β-blocker, a calcium channel blocker, and a converting enzyme inhibitor in hypertensive blacks. Arch Intern Med 1990; 150: 1707–13PubMedCrossRef
28.
Zurück zum Zitat Schrier RW, Estacio RO. Additional follow-up from the ABCD trial in patients with type 2 diabetes and hypertension. [letter] N Engl J Med 2000; 343: 1969PubMedCrossRef Schrier RW, Estacio RO. Additional follow-up from the ABCD trial in patients with type 2 diabetes and hypertension. [letter] N Engl J Med 2000; 343: 1969PubMedCrossRef
29.
Zurück zum Zitat Elliott WJ. Higher incidence of discontinuation of angiotensin converting enzyme inhibitors due to cough in black subjects. Clin Pharmacol Ther 1996; 60: 582–8PubMedCrossRef Elliott WJ. Higher incidence of discontinuation of angiotensin converting enzyme inhibitors due to cough in black subjects. Clin Pharmacol Ther 1996; 60: 582–8PubMedCrossRef
30.
Zurück zum Zitat Herings RMC, de Boer A, Stricker BHCH, et al. Hypoglycemia associated with use of inhibitors angiotensin converting enzyme. Lancet 1995; 345: 1194–8CrossRef Herings RMC, de Boer A, Stricker BHCH, et al. Hypoglycemia associated with use of inhibitors angiotensin converting enzyme. Lancet 1995; 345: 1194–8CrossRef
31.
Zurück zum Zitat Bakris GL, Weir MR. Angiotensin-converting enzyme inhibitor-associated elevations in serum creatinine. Arch Intern Med 2000; 160: 685–93PubMedCrossRef Bakris GL, Weir MR. Angiotensin-converting enzyme inhibitor-associated elevations in serum creatinine. Arch Intern Med 2000; 160: 685–93PubMedCrossRef
32.
33.
Zurück zum Zitat Conlin PR, Spence JD, Williams B, et al. Angiotensin II antagonists for hypertension: are there differences in efficacy? Am J Hypertens 2000; 13: 418–26PubMedCrossRef Conlin PR, Spence JD, Williams B, et al. Angiotensin II antagonists for hypertension: are there differences in efficacy? Am J Hypertens 2000; 13: 418–26PubMedCrossRef
34.
Zurück zum Zitat Timmermans PB, Wong PC, Chiu AT, et al. Angiotensin II receptors and angiotensin II receptor antagonists. Pharmacol Rev 1993; 45: 205–51PubMed Timmermans PB, Wong PC, Chiu AT, et al. Angiotensin II receptors and angiotensin II receptor antagonists. Pharmacol Rev 1993; 45: 205–51PubMed
35.
Zurück zum Zitat Toto R, Schultz P, Raij L, et al. Efficacy and tolerability of losartan in hypertensive patients with renal impairment. Hypertension 1998; 31: 684–91PubMedCrossRef Toto R, Schultz P, Raij L, et al. Efficacy and tolerability of losartan in hypertensive patients with renal impairment. Hypertension 1998; 31: 684–91PubMedCrossRef
36.
Zurück zum Zitat Bakris GL, Siamos M, Richardson D, et al. ACE inhibition or angiotensin receptor blockade: impact on potassium in renal failure. Kidney Int 2000; 58: 2084–92PubMedCrossRef Bakris GL, Siamos M, Richardson D, et al. ACE inhibition or angiotensin receptor blockade: impact on potassium in renal failure. Kidney Int 2000; 58: 2084–92PubMedCrossRef
37.
Zurück zum Zitat Cummings DM, Amadio Jr P, Nelson L, et al. The role of calcium channel blockers in the treatment of essential hypertension. Arch Intern Med 1991; 151: 250–9PubMedCrossRef Cummings DM, Amadio Jr P, Nelson L, et al. The role of calcium channel blockers in the treatment of essential hypertension. Arch Intern Med 1991; 151: 250–9PubMedCrossRef
38.
Zurück zum Zitat Furberg CD, Psaty BM, Meyer JV. Nifedipine. Dose-related increase in mortality in patients with coronary heart disease. Circulation 1995; 92: 1326–31PubMedCrossRef Furberg CD, Psaty BM, Meyer JV. Nifedipine. Dose-related increase in mortality in patients with coronary heart disease. Circulation 1995; 92: 1326–31PubMedCrossRef
39.
Zurück zum Zitat Fleckenstein A. History and prospects in calcium antagonist research. J Mol Cell Cardiol 1990; 22: 241–51PubMedCrossRef Fleckenstein A. History and prospects in calcium antagonist research. J Mol Cell Cardiol 1990; 22: 241–51PubMedCrossRef
40.
Zurück zum Zitat Luscher TF, Cosentino F. The classification of calcium antagonists and their selection in the treatment of hypertension. Drugs 1998; 55: 509–17PubMedCrossRef Luscher TF, Cosentino F. The classification of calcium antagonists and their selection in the treatment of hypertension. Drugs 1998; 55: 509–17PubMedCrossRef
41.
Zurück zum Zitat Hamada T, Watanabe M, Kaneda T, et al. Evaluation of changes in sympathetic nerve activity and heart rate in essential hypertensive patients induced by amlodipine and nifedipine. J Hypertens 1998; 16: 111–8PubMedCrossRef Hamada T, Watanabe M, Kaneda T, et al. Evaluation of changes in sympathetic nerve activity and heart rate in essential hypertensive patients induced by amlodipine and nifedipine. J Hypertens 1998; 16: 111–8PubMedCrossRef
43.
Zurück zum Zitat Hall WD, Reed JW, Flack JM, et al. Comparison of the efficacy of dihydropyridine calcium channel blockers in African American patients with hypertension. Arch Intern Med 1998; 158: 2029–34PubMedCrossRef Hall WD, Reed JW, Flack JM, et al. Comparison of the efficacy of dihydropyridine calcium channel blockers in African American patients with hypertension. Arch Intern Med 1998; 158: 2029–34PubMedCrossRef
44.
Zurück zum Zitat Staessen JA, Gasowski J, Wang JG, et al. Risks of untreated and treated isolated systolic hypertension in the elderly. Lancet 2000; 355: 865–72PubMedCrossRef Staessen JA, Gasowski J, Wang JG, et al. Risks of untreated and treated isolated systolic hypertension in the elderly. Lancet 2000; 355: 865–72PubMedCrossRef
45.
Zurück zum Zitat Packer M, O’Connor CM, Ghali JK, et al. Effect of amlodipine on morbidity and mortality in severe chronic heart failure. N Engl J Med 1996; 335: 1107–14PubMedCrossRef Packer M, O’Connor CM, Ghali JK, et al. Effect of amlodipine on morbidity and mortality in severe chronic heart failure. N Engl J Med 1996; 335: 1107–14PubMedCrossRef
46.
Zurück zum Zitat Feigin VL, Rinkel GJE, Algra A, et al. Calcium antagonists in patients with aneurysmal subarachnoid hemorrhage. Neurology 1998; 50: 876–83PubMedCrossRef Feigin VL, Rinkel GJE, Algra A, et al. Calcium antagonists in patients with aneurysmal subarachnoid hemorrhage. Neurology 1998; 50: 876–83PubMedCrossRef
47.
Zurück zum Zitat Grossman E, Messerli FH, Grodzicki T, et al. Should a moratorium be placed on sublingual nifedipine capsules given for hypertensive emergencies and pseudoemergencies? JAMA 1996; 276: 1328–31PubMedCrossRef Grossman E, Messerli FH, Grodzicki T, et al. Should a moratorium be placed on sublingual nifedipine capsules given for hypertensive emergencies and pseudoemergencies? JAMA 1996; 276: 1328–31PubMedCrossRef
48.
Zurück zum Zitat Psaty BM, Heckbert SR, Koepsell TD, et al. The risk of myocardial infarction associated with antihypertensive drug therapies. JAMA 1995; 274: 620–5PubMedCrossRef Psaty BM, Heckbert SR, Koepsell TD, et al. The risk of myocardial infarction associated with antihypertensive drug therapies. JAMA 1995; 274: 620–5PubMedCrossRef
49.
Zurück zum Zitat Alderman MH, Cohen H, Roqué R, et al. Effect of long-acting and short-acting calcium antagonists on cardiovascular outcomes in hypertensive patients. Lancet 1997; 349: 594–8PubMedCrossRef Alderman MH, Cohen H, Roqué R, et al. Effect of long-acting and short-acting calcium antagonists on cardiovascular outcomes in hypertensive patients. Lancet 1997; 349: 594–8PubMedCrossRef
50.
Zurück zum Zitat Bailey DG, Dresser GK, Kreeft JH, et al. Grapefruit-felodipine interaction. Clin Pharmacol Ther 2000; 68: 468–77PubMedCrossRef Bailey DG, Dresser GK, Kreeft JH, et al. Grapefruit-felodipine interaction. Clin Pharmacol Ther 2000; 68: 468–77PubMedCrossRef
51.
Zurück zum Zitat Malhotra S, Bailey DG, Paine MF, et al. Seville orange juice-felodipine interaction. Clin Pharmacol Ther 2001; 69: 14–23PubMedCrossRef Malhotra S, Bailey DG, Paine MF, et al. Seville orange juice-felodipine interaction. Clin Pharmacol Ther 2001; 69: 14–23PubMedCrossRef
52.
Zurück zum Zitat Khatri I, Uemura N, Notargiacomo A, et al. Direct and reflex cardiostimulating effects of hydralazine. Am J Cardiol 1977; 40: 38–42CrossRef Khatri I, Uemura N, Notargiacomo A, et al. Direct and reflex cardiostimulating effects of hydralazine. Am J Cardiol 1977; 40: 38–42CrossRef
53.
Zurück zum Zitat Ram CVS. Direct vasodilators. In: Hypertension primer. Dallas (TX): American Heart Association, 1999: 385–7 Ram CVS. Direct vasodilators. In: Hypertension primer. Dallas (TX): American Heart Association, 1999: 385–7
54.
55.
Zurück zum Zitat Campese VM. Minoxidil: a review of its pharmacological properties and therapeutic use. Drugs 1981; 22: 257–78PubMedCrossRef Campese VM. Minoxidil: a review of its pharmacological properties and therapeutic use. Drugs 1981; 22: 257–78PubMedCrossRef
56.
Zurück zum Zitat Ram CVS. Refractory hypertension. In: Weber MA, editor. Hypertension medicine. Totowa (NJ): Humana Press, 2001: 429–36 Ram CVS. Refractory hypertension. In: Weber MA, editor. Hypertension medicine. Totowa (NJ): Humana Press, 2001: 429–36
57.
Zurück zum Zitat Ram CVS, Fenves A. Hypertension. In: Rakel RE, editor. Conn’s current therapy. Philadelphia (PA): WB Saunders, 2000: 303–14 Ram CVS, Fenves A. Hypertension. In: Rakel RE, editor. Conn’s current therapy. Philadelphia (PA): WB Saunders, 2000: 303–14
58.
Zurück zum Zitat Lundeen TE, Dolan DJ, Ram CV. Pericardial effusion associated with minoxidil therapy. Postgrad Med 1981; 70: 98–100PubMed Lundeen TE, Dolan DJ, Ram CV. Pericardial effusion associated with minoxidil therapy. Postgrad Med 1981; 70: 98–100PubMed
Metadaten
Titel
Antihypertensive Drugs
An Overview
verfasst von
Professor C. Venkata S. Ram
Publikationsdatum
01.03.2002
Verlag
Springer International Publishing
Erschienen in
American Journal of Cardiovascular Drugs / Ausgabe 2/2002
Print ISSN: 1175-3277
Elektronische ISSN: 1179-187X
DOI
https://doi.org/10.2165/00129784-200202020-00002

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