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The evolution of current hypertension therapy
1Division of Clinical Pharmacology, University of Pittsburgh School of Medicine, Pennsylvania 15261.
Insights
Hypertension therapy has evolved, offering many agents. While lowering blood pressure reduces stroke risk, consistent decreases in overall mortality are not yet proven, especially in older adults.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Hypertension therapy has significantly evolved over 30 years, with over 40 available agents.
- Large trials confirm blood pressure reduction lowers stroke and coronary heart disease incidence in mild to moderate hypertension.
- The impact on overall mortality remains inconsistent, and older adults are underrepresented in major trials.
Purpose of the Study:
- To review the evolution of hypertensive therapy.
- To assess the efficacy of current hypertension management strategies.
- To question the universal applicability of the stepped-care approach given new therapeutic options.
Main Methods:
- Review of large-scale clinical trials on hypertension management.
- Analysis of therapeutic agents and their side-effect profiles.
- Examination of treatment outcomes, including stroke, coronary heart disease, and mortality rates.
Main Results:
- Established efficacy of blood pressure lowering in reducing stroke and coronary heart disease incidence.
- Inconsistent findings regarding the reduction of overall mortality rates.
- Limited data on the effectiveness of hypertension management in individuals over 60 years of age.
Conclusions:
- The stepped-care approach for hypertension may need re-evaluation.
- The wide array of agents with similar efficacy but different side effects challenges a one-size-fits-all strategy.
- Further research is needed on hypertension management in the elderly population.
Abstract:
There has been a continuous evolution in hypertensive therapy during the last 30 years. Now, physicians have access to more than 40 agents for treating this widespread condition. Large-scale clinical trials have established that lowering blood pressure in patients with mild to moderate diastolic hypertension results in a decreased incidence of stroke and, to a lesser extent, a reduction in incidence of coronary heart disease [MacMahon SW, Cutler JA, Furberg CD, et al: Prog Cardiovasc Dis 1986; 29 (suppl 1): 99-118]. Even so, the decrease in overall mortality rate is not consistent. Although hypertension occurs with increasing frequency in those over 60 years of age, patients in this age group represent less than 12 percent of the subjects in large trials. Currently, stepped-care is the recommended approach for managing hypertension in patients of all ages. However, the availability of a variety of agents for initial therapy, all with approximately equal efficacy but differing side-effect profiles, calls such an approach into question.