Medicus, Vol. 12 No. 1_ Kardiologija, 2003.
Pregledni rad
How to Optimally Treat Arterial Hypertension?
Duško Kuzmanić
Mario Laganović
Sažetak
Arterial hypertension is the main independent
factor of cardiovascular risk. Thus the decrease in blood
pressure reduces the frequency of cardiovascular and cerebrovascular
complications. During this year, the American (JNC
VII) and European (ESH/ESC) guidelines were published,
designed for the care of patients with arterial hypertension.
This review points to the basic principles and aims of treating
a hypertensive patient. The main goal of treatment is the
reduction of the total risk of cardiovascular morbidity and mortality,
including the treatment of reversible risk factors, associated
clinical states and elevated blood pressure per se.
According to the ESH/ESC guidelines, the main groups of
drugs - diuretics, beta-adrenergic blockers, ACE-inhibitors, calcium
channels blockers, angiotensin receptor blockers - are all
appropriate for the onset and maintenance of antihypertensive
therapy. The JNC VII guidelines focus on thiazide diuretics as
the initial therapy in the majority of patients. It must be
stressed that some drug groups can have advantage in front
of the others in certain clinical states (cardiac decompensation,
myocardial infarction, diabetes and renal diseases, prevention
of stroke). The comparison of the efficacy of the "new"
(ACE-inhibitors, calcium channel blockers) and the "old"
(diuretics, beta-adrenergic blockers) medicaments showed
that substantial difference in the degree of cardiovascular protection
does not exist. Calcium blockers are better in the prevention
of cerebrovascular incidents, which the risk of cardiac
decompensation is greater during the administration of calcium
channel blockers and alpha-adrenergic blockers. The thesis
that the "new" antihypertensive drugs (calcium channel
blockers, ACE-inhibitors, angiotensin receptor blockers, alphaadrenergic
blockers) influence the cardiovascular prognosis
along with antihypertensive effect, still remains unconfirmed.
The main benefit of antihypertensive therapy is in the decrease
in blood pressure, and in a lesser degree in additional impacts
of a drug. These data point at the importance of the strict
blood pressure control. However, the target value to be
achieved is unknown as yet.
Ključne riječi
hypertension; drugs; prescribing
Hrčak ID:
20510
URI
Datum izdavanja:
27.1.2003.
Posjeta: 2.997 *