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[Delayed-action calcium antagonists and therapy of arterial hypertension]
1Faculdade de Medicina de Lisboa, Hospital de Santa Maria.
Insights
Effective hypertension management involves non-pharmacological approaches and drug treatments. Long-acting medications like diltiazem improve patient compliance and control blood pressure over 24 hours, potentially reducing healthcare costs.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
Context:
- Hypertension management has advanced significantly, requiring drug treatment for moderate to severe cases.
- Non-pharmacological methods are crucial but often insufficient alone for effective blood pressure control.
- Accurate diagnosis and monitoring, including ambulatory blood pressure measurement, are vital for treatment decisions.
Purpose:
- To review advancements in hypertension drug treatment and non-pharmacological management.
- To discuss the role of quantitative diagnosis and ambulatory blood pressure monitoring.
- To evaluate the efficacy of long-acting calcium channel blockers, exemplified by slow-release diltiazem, for 24-hour blood pressure control.
Summary:
- Drug therapies have greatly improved hypertension control, preventing cardiovascular complications.
- Ambulatory blood pressure monitoring offers a more comprehensive diagnostic tool than casual measurements.
- Slow-release diltiazem, taken once daily, demonstrates favorable pharmacokinetics and pharmacodynamics for sustained blood pressure management.
Impact:
- Improved patient compliance and reduced hypertensive spikes with once-daily dosing.
- Potential for significant reduction in healthcare costs associated with hypertension management.
- Enhanced understanding of long-acting drug benefits in achieving 24-hour blood pressure control.
Abstract:
Drug treatment of high blood pressure had important improvements is the last few decades, that allowed an efficiente control of hypertension, avoiding or stabilysing cardiovascular consequences. Non pharmacological management is always important; however most hypertensive patients need also drug treatment that is unavoiable in severe and in most cases of moderate hypertension. Borderline hypertension involves difficult decisions. Quantitative diagnosis of high blood pressure has been based on casual measurement. Non invasive ambulatory blood pressure measurement gives access to much more valures over the whole day and night periods, and has been an important tool for clinical research. However it implicates a correct assessment of the device's accuracy and calibration, and also a correct statistical treatment of the huge range of values obtained. Blood pressure control over the 24 hours is probably obtained with some long acting drugs. So, calcium antagonista are reviewed, exemplofying with slow release diltiazem. It has been prescribed twicely a day, and more recently once a day, what is considered by some authors quite adequate on the point of view of pharmacocinetics and pharmacodynamics. So the benefits depending on patient's compliance and the possible obliteration of hypertensive spikes may be important. There is perhaps, in the overall, reduction of health care costs, in what concerns hypertension.