Related Experiment Videos

A rational approach to the treatment of hypertension in special populations

W D Hall1

  • 1Emory University School of Medicine, Atlanta, Georgia, USA.

American Family Physician
|July 22, 1999
PubMed

Insights

Blacks with hypertension often have low renin and respond well to diuretics or calcium channel blockers. Treatment guidelines for older adults focus on isolated systolic hypertension and combined hypertension in specific age groups.

Area of Science:

  • Cardiology
  • Nephrology
  • Geriatrics

Background:

  • Hypertension in Black individuals typically presents with low renin, expanded volume, and salt sensitivity.
  • Older adults commonly experience isolated systolic hypertension (ISH) or combined systolic and diastolic hypertension (SHTN).

Purpose of the Study:

  • To review the optimal management strategies for hypertension in Black patients.
  • To outline evidence-based treatment recommendations for hypertension in older adults, differentiating between ISH and SHTN.

Main Methods:

  • Literature review of studies on hypertension management in specific populations.
  • Analysis of treatment responses to various antihypertensive drug classes, including diuretics, calcium channel antagonists, beta-blockers, and ACE inhibitors.
  • Evaluation of clinical trial data supporting hypertension treatment in older adults (60-96 years).

Main Results:

  • Diuretics and calcium channel antagonists show good efficacy as initial therapies for hypertension in Black patients.
  • Beta-blockers and angiotensin-converting enzyme (ACE) inhibitors demonstrate blunted responses in monotherapy for Black patients, but efficacy improves with diuretics.
  • Strong evidence supports treating combined hypertension in patients aged 60-79 and ISH in patients aged 60-96.
  • Diuretics and long-acting dihydropyridine calcium channel antagonists are recommended for ISH in older adults.

Conclusions:

  • Tailored antihypertensive strategies are crucial for Black patients, favoring diuretics or calcium channel blockers.
  • Established guidelines exist for treating hypertension in older adults, particularly ISH and combined hypertension within specific age brackets.
  • Further research is needed to establish treatment guidelines for combined hypertension in individuals aged 80 and older.

Related Concept Videos

Hypertension IV: Drug Therapy and Lifestyle Modifications01:28

Hypertension IV: Drug Therapy and Lifestyle Modifications

Multiple classes of antihypertensive medications are employed in treating hypertension. The most commonly recommended first-line treatments include:Thiazide Diuretics, such as chlorthalidone, increase sodium and water excretion from the body, reducing blood volume and blood pressure.Angiotensin-converting enzyme inhibitors, like lisinopril, block the conversion of angiotensin I to II, a potent vasoconstrictor lowering blood pressure.Angiotensin II Receptor Blockers (ARBs) prevent angiotensin II...
Hypertension V: Nursing Management01:23

Hypertension V: Nursing Management

The nursing management of hypertension involves accurately assessing symptoms, making a comprehensive nursing diagnosis, collaborating with patients to set goals, and implementing targeted interventions to mitigate the condition's impact and improve patient well-being.Comprehensive AssessmentThe initial step in nursing care for hypertension involves a thorough patient assessment. It includes evaluating symptoms such as headaches, dizziness, blurred vision, and previous hypertension episodes.
Hypertension III: Clinical Manifestations and Diagnostic Studies01:30

Hypertension III: Clinical Manifestations and Diagnostic Studies

Hypertension is asymptomatic and also referred to as the "silent killer" until it progresses to a severe stage or causes target organ disease. Patients may experience symptoms stemming from the strain on blood vessels and tissues in various organs or the heart's increased workload.Physical exams might show no abnormalities other than high blood pressure. Signs of vascular damage, when present, correspond to the organs supplied by the affected vessels, leading to target organ damage. For...
Hypertension and Regulation of Blood Pressure01:18

Hypertension and Regulation of Blood Pressure

Hypertension, the most common cardiovascular disease, is diagnosed through repeated measurements of elevated blood pressure. Its risks, including damage to the kidney, heart, and brain, are directly proportional to blood pressure levels. Starting from 115/75 mm Hg, the risk of cardiovascular disease doubles with each increment of 20/10 mm Hg. The diagnosis relies on blood pressure measurements, not on patient symptoms, as hypertension is often asymptomatic until end-organ damage is imminent or...
Hypertension I: Introduction01:28

Hypertension I: Introduction

Hypertension is a widespread, long-term medical condition where blood pressure in the arteries remains elevated. It is characterized by systolic blood pressure readings of 130 mm Hg or above or diastolic blood pressure (DBP) readings of 80 mm Hg or higher. Unmanaged hypertension poses significant health risks, making the distinction between primary (or essential) hypertension and secondary hypertension crucial, as their management and implications vary.Primary HypertensionPrimary hypertension,...
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...