Selected factors that influence responses to antihypertensives. Choosing therapy for the uncomplicated patient

A Cluster Randomized Trial to Evaluate Physician/Pharmacist Collaboration to Improve Blood Pressure Control

“…Of importance, BP was controlled to current standards in 81.8% of patients with diabetes. Mean BP began to diverge at the 2‐month visit and became significant at 4 to 6 months; this may have been secondary to the pharmacodynamic delay in antihypertensive response 36 …”

Antihypertensive Medication Use Among Recruits for the Trial of Nonpharmacologic Interventions in the Elderly (TONE)

“…Pharmacological antihypertensive therapy has been demonstrated to be effective in both women and men 26–28 . Consensus guidelines and recommendations advise specifically that gender is not a basis for choosing the class of antihypertensive medication, and accumulated evidence suggests that the considerations for choosing an antihypertensive medication for postmenopausal women should be similar to those for men 10,12,29 . Thus, the gender‐related differences observed in the prescription of antihypertensive medications in TONE and CHS are difficult to explain.…”

“…Guidance on selecting first line therapy includes many specifics relevant to indications or contraindications in older adults 9–12 and has changed as new classes of medications have appeared on the market and as results of trials have confirmed or raised questions about the efficacy or adverse effects of specific drugs. In 1993, the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure 10 recommended diuretics and β‐blockers as the first choices for antihypertensive medications because these were the only two classes of drugs considered to have been shown by long‐term controlled clinical trials to reduce morbidity and mortality, but they also recognized situations when other treatments were appropriate.…”

Hydrochlorothiazide Versus Chlorthalidone

“…It is known that pharmacokinetic parameters differ at steady state, especially in the elderly, in patients with renal insufficiency, or with drug-drug interactions. [25][26][27][28][29] Another important principle with antihypertensive agents is that their pharmacodynamic response is generally much longer than their half-life would predict. [27][28][29] For these reasons, most antihypertensive drugs can be given once or twice daily despite half-lives that would predict the need for more frequent dosing.…”