Update on the Management of Hypertension: Do Recent Clinical Trial Results Indicate a Change in National Recommendations for Therapy?

Abstract

Numerous hypertension treatment trials have been reported during the past several years. In comparative studies it has been shown that the use of diuretics or diuretics/β blockers has resulted in a reduction in mor-T his review will summarize the recommendations of the 1997 Joint National Committee on Prevention, Diagnosis, Evaluation, and Treatment of High Blood Pressure (JNC VI) 1 and discuss possible changes in these based on the results of clinical trials held over the past 3-4 years.In 1997 the JNC VI emphasized the importance of systolic blood pressure (SBP) both in estimating risk and guiding therapy. This point should be reemphasized. Most physicians would not hesitate to treat a patient with a persistent diastolic blood pressure (DBP) of 95-100 mm Hg but, based on recent treatment surveys, many do not treat an SBP of 150-159 mm Hg. Yet, the relative risk of a cardiac event with this level of SBP is considerably greater than the risk of a DBP of 95-100 mm Hg (Figure 1). 2 A majority of hypertensive patients who are uncontrolled are those with SBP elevations. In addition, data from Framingham indicate that over time people with SBP levels of 140-159 mm Hg have a poorer prognosis when compared to those with SBPs below 140 mm Hg (Table I). 3 At the end of a long follow-up period, cardiovascular (CV) disease, coronary heart disease, transient ischemic attacks, heart failure, and CV disease deaths were all increased statistically significantly more in those individuals who originally had this degree of

Interpreting antioxidant responses to angiotensin AT1 receptor antagonists: pharmacology or chemistry?

“…The efficacy of targeting the renin-angiotensin system (RAS) in the treatment of hypertension is well defined and has been the subject of numerous clinical trials [1][2][3].…”