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Long-term clinical trials in hypertension.
1Department of Hypertension and Nephrology, Cleveland Clinic Foundation, Ohio 44195-5042.
Summary
Diuretic-based antihypertensive therapy effectively reduces cerebrovascular events and improves cardiovascular health across diverse populations. This approach is recommended for hypertension management, especially in elderly patients.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Long-term clinical trials provide evidence for antihypertensive therapies.
- Diuretic-based therapy has a history of reducing cardiovascular events.
Purpose of the Study:
- To summarize the established benefits of diuretic-based antihypertensive therapy.
- To discuss the initiation threshold for antihypertensive treatment.
- To evaluate the role of diuretics in elderly patients with hypertension.
Main Methods:
- Review of long-term clinical trial data on antihypertensive therapies.
- Analysis of outcomes related to cerebrovascular events, left ventricular hypertrophy, retinopathy, and hypertension progression.
- Consideration of patient demographics including age, race, and gender.
Main Results:
- Diuretic-based therapy consistently reduced fatal and non-fatal cerebrovascular events across all demographics.
- ECG left ventricular hypertrophy, retinopathy, and hypertension progression were reduced.
- Cardiomegaly and ECG left ventricular hypertrophy were reversed.
- Elderly patients (up to age 80) with diastolic hypertension benefit from diuretics.
Conclusions:
- Initiating antihypertensive therapy is recommended when diastolic blood pressure is ≥ 90 mmHg after non-pharmacologic treatment.
- Diuretic-based therapy is a proven effective strategy for managing hypertension and preventing cardiovascular complications.
- Further long-term trials are needed to compare diuretics with ACE inhibitors and calcium channel blockers as initial therapies.