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Current therapy, present limitations and future goals for systemic hypertension
Insights
Despite advances, hypertension control remains a challenge, with many patients inadequately managed. Newer therapies like calcium channel blockers offer improved metabolic profiles for better cardiovascular outcomes in hypertension treatment.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Significant progress in hypertension recognition and treatment over two decades.
- Two-thirds of US hypertensive patients remain inadequately controlled.
- Antihypertensive therapy's impact on coronary artery disease (CAD) morbidity and mortality is not conclusively demonstrated.
Purpose of the Study:
- To address persistent challenges in hypertension control.
- To evaluate newer antihypertensive therapies potentially overcoming limitations of traditional treatments.
- To highlight the role of calcium channel blockers in hypertension management.
Main Methods:
- Review of antihypertensive therapy, focusing on traditional step-care (diuretics, beta blockers) and newer agents.
- Assessment of metabolic and hemodynamic profiles of different drug classes.
- Examination of clinical outcomes related to coronary artery disease.
Main Results:
- Traditional therapies (diuretics, beta blockers) are associated with unfavorable metabolic effects.
- These metabolic effects may hinder the demonstration of decreased coronary artery disease.
- Newer antihypertensive agents, particularly calcium channel blockers, offer favorable metabolic and hemodynamic profiles.
- Nitrendipine, a long-acting 1,4 dihydropyridine calcium channel blocker, shows promising results.
Conclusions:
- Reappraisal of traditional step-care antihypertensive therapy is warranted.
- Calcium channel blockers are effective, well-tolerated, and metabolically favorable options.
- Nitrendipine represents a promising new agent for effective hypertension treatment.
Abstract:
During the past 2 decades, encouraging strides have been made in the recognition and treatment of patients with high blood pressure and in the development of antihypertensive therapy. Concerns surrounding the control of hypertension, however, continue to emerge. As many as two-thirds of hypertensive patients in the US remain inadequately controlled. Although overall cardiovascular mortality has declined since the mid- 1960s, a significant impact of antihypertensive therapy on coronary artery disease morbidity and mortality has not been conclusively demonstrated. Unfavorable metabolic effects associated with traditional step-care antihypertensive therapy with diuretics and beta blockers are increasingly implicated for failure to demonstrate a decrease in coronary artery disease. The availability of newer efficacious antihypertensive therapy that does not adversely affect metabolic parameters is resulting in a reappraisal of traditional step-care. Of particular interest are the calcium channel blockers, because they are efficacious, well tolerated and offer favorable metabolic and hemodynamic profiles. Nitrendipine is a new long-acting member of the 1,4 dihydropyridine class of calcium channel blockers that has shown encouraging results for treatment of hypertension.