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Hypertenstion Management

Posted on May 28, 2021 | 1 Comment on Hypertenstion Management

Clinical evidence has shown the necessity for the use of combination therapy, or the use of two or more antihypertensive agents, in the management of hypertension. Observations from major clinical trials in different kinds of patients, from elderly to stroke and diabetic patients, indicate that usually two agents are necessary to control the blood pressure in the majority of these patients.

The recent cardiovascular summit held in Prague last March 2007 focused on how the management of hypertension could be improved through combination therapy. The diuretic combinations are widely used for hypertension.”Diuretic combinations are widely practiced ‘or the reason that it is the fastest drug to decrease blood pressure,” said Dr. Josep Galceran of Manresa, Spain. Diuretics also help the kidneys eliminate salt and water, decreasing =iuid volume throughout the body and ;nus lowering blood pressure.

However, diuretics can-also increase ;7e level of blood sugar. This causes -oncern over the use of the drug ~,ecause increased ‘blood sugar evel is a marker for diabetes. The -~ntihypertensive and Lipid-lowering Treatment to Prevent Heart Attack ALLHAT) trial showed that compared 😮 other classes of anti-hypertensive ::rugs, the use of thiazide diuretics -~crease a patient’s risk of having -ew-onset diabetes as the therapy – rogresses. In addition, those hypertensive patients affected with new-onset diabetes (NOD) are most likely to have higher glucose levels, higher occurrence of impaired glucose tolerance,highersystolic and diastolic blood pressure and some extent of left ventricular hypertrophy.

Because of the mentioned sideeffects, researchers are studying other combinations . that would not only effectively manage blood pressure but are also safer. Dr. George S. Stergiou from the Hypertension Center of Sotiria Hospital in Athens, Greece, cited the importance of raising the standard of antihypertensive care. He emphasized paying attention to how effective both short-term and long-term effects of the therapies.

According to Stergiou, first consider how effective the antihypertensive agent is in lowering blood pressure. Secondly, limit the adverse effects associated with the treatment to prevent treatment non-compliance.

Among the combination therapies, the verapamil-trandolapril combination showed effective blood pressure lowering minus adverse effects, particularly the incidence of new-onset diabetes as seen in the Study of Trandolapril-Verapamil and Insulin Resistance (STAR) trial. STAR sought to find out if glycemic control could be maintained to a greater degree with a renin angiotensin (RAS) inhibitor/nondihydropyridine calcium channel blocker (verapamil SR/trandolapril) combination compared with a RAS inhibitor-thiazide diuretic (losartan/ hydrochlorothiazide) combination in hypertensive patients with metabolic syndrome.

Results of the trial showed that both combinations notably lowered patient’s blood pressure, losartan/ HCTZ caused an increase in glucose, insulin and HbA I c levels. In contrast, verapamil SR/trandolapril had a neutral effect on glucose tolerance. Furthermore,a six month extension of the STAR trial showed that switching to verapamil SR/ trandolapril combination therapy reversed the unfavorable side effect on glycemic control brought about by using losartan/HCTZ.

With the favorable results of STAR trial, the combination of verapamil SR/trandolapril can prove to be an ideal choice for hypertensive patients requiring combination therapy.The verapamil SR/trandolapril combination is marketed in the Philippines by Abbott Laboratories under the brand name Tarka.

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  1. Mason Parker Reply

    hypertension can be minimized by taking some food supplements like fish oil and CoQ10.

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