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[Primary and secondary prevention in hypertensive patients. An assessment of current status]
1Gesellschaft für klinische Pharmakologie, Wien.
Insights
Long-term beta-receptor-antagonists are recommended after myocardial infarction. For primary prevention in high-risk patients, beta-receptor-antagonists, potentially with diuretics, are preferred over diuretics alone.
Area of Science:
- Cardiology
- Pharmacology
Context:
- Established myocardial infarction treatment guidelines.
- Primary prevention strategies for hypertension and cardiovascular disease.
Purpose:
- To outline the appropriate use of beta-receptor-antagonists in post-myocardial infarction patients.
- To guide the selection of first-line therapy for older hypertensives and high-risk cardiovascular patients.
Summary:
- Beta-receptor-antagonists without intrinsic sympathomimetic activity are recommended for long-term use post-myocardial infarction.
- Cardioselectivity and lipophilicity are less critical than intrinsic sympathomimetic activity.
- Diuretics are first-line for older hypertensives; beta-receptor-antagonists (with or without diuretics) are preferred for high-risk cardiovascular patients.
Impact:
- Informs clinical practice regarding beta-blocker selection and long-term management.
- Provides evidence-based recommendations for primary cardiovascular disease prevention strategies.
Abstract:
The effect of a long-term treatment with beta-receptor-antagonists after an established myocardial infarction is generally accepted. Beta-receptor-antagonists without intrinsic sympathicomimetic activity should be used, cardioselectivity is of lesser importance, except in patients with special problems (i.e. increased bronchial resistance, decreased peripheral blood flow etc.). Hydrophilic or lipophilic properties do not play any role. For primary prophylaxis in older hypertensives diuretics are the drugs of first line, in patients with high risk for heart- and blood-vessel diseases however beta-receptor-antagonists--eventually in combination with low doses of diuretics-should be chosen.