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Cancel Continue. In a recent clinical trial led by researchers from the George Institute for Global Health — with branches in the United Kingdom, Australia, and India — they tested the effectiveness and safety of using an innovative drug for the treatment of high blood pressure , or hypertension.
Namely, these are: telmisartan 20 milligrams , amlodipine 2. According to World Health Organization WHO data from , about 40 perecent of adults aged over 25 had raised blood pressure worldwide. The WHO also estimate that hypertension is responsible for 7. That is because this condition is a major risk factor for both heart disease and stroke , making it a priority to have effective treatments in place for the regulation of blood pressure.
Normally, people with hypertension start taking one blood pressure drug at low doses, only to have to return to their doctors time and again. They then get prescriptions for increasingly higher doses and more hypertension drugs. According to study co-author Dr. So, Dr. Figure 4 illustrates the time trends in the use of major classes of antihypertensive drugs stratified on the presence or absence of CAD. Despite the expected increases in systolic BP with the advancing age of the CHS cohort, the awareness, treatment, and control of high BP improved steadily during the s.
The proportions of subjects aware and treated were higher among blacks than whites, though control was similar. The proportion with control of treated hypertension depended importantly on the systolic BP criterion. The improvement in control may have been achieved in part by a greater use of multidrug therapy in those who were treated—a mean increase of 0. Improved control in the cohort was also achieved by increasing the proportion of CHS participants who were treated from In the present study, the time trends represent findings in a cohort observed over time, and as the cohort ages, the characteristics may become unrepresentative of a random sample of adults 65 years or older.
In this observational study, participants and their physicians were also informed of the study BP levels, and the protocol included appropriate "alerts" defined by the level of the increased BP. These "observational interventions" probably affected levels of awareness, treatment, and control over time. In Figure 1 B, for instance, the new members of the black cohort entered the study in ; their control level was significantly lower than that of whites, who had been in the study for several years; and by the next year, after they and their physicians would have received feedback on their baseline BP levels, the proportion of black subjects with controlled BP had improved.
Other studies have suggested little or no improvement in awareness, treatment, and control of high BP in the late s and early s. In a survey of physicians conducted by Oliveria and colleagues, 37 the average systolic BP thought to require treatment in patients without comorbidities was These physician-survey findings are consistent with the levels and types of control seen in the CHS.
Diastolic BP has been a traditional target and, even in older adults, is directly related to the risk of cardiovascular events. Based on epidemiologic evidence and extrapolations from clinical trial experience, the expected public health benefit of more aggressive treatment of systolic hypertension is likely to be large.
High BP is a common condition among older adults. Treatment trials, moreover, have not been conducted specifically in patients with mild elevations of systolic BP. Borderline isolated systolic hypertension is the only hypertension condition for which a placebo-controlled major-disease end point trial would not be clearly unethical.
Perhaps the results of clinical trials that are currently under way will help persuade physicians of the importance of aggressive treatment of mild to moderate elevations of systolic blood pressure. The idea of starting combination therapy for all patients with hypertension, advocated by some, 44 is unnecessary for half the hypertension population, would subject these patients to the unnecessary costs and risks of a second medication, and remains untested as an approach to reduce the cardiovascular morbidity and mortality associated with hypertension.
Calcium channel blockers and ACE inhibitors were available and began to increase in use from the early s. A number of studies have noted the trends in antihypertensive drug therapy during the late s and early s. In hypertensive patients without CAD, the use of diuretics has declined precipitously even though clinical trials, several published in and , 6 , 56 have shown that low-dose diuretics are safe and effective in preventing stroke, myocardial infarction, heart failure, and total mortality.
The first and only trial to suggest a benefit from the calcium channel blocker nitrendipine, a placebo-controlled trial in isolated systolic hypertension, was published only in Between and , 59 for instance, the proportion of all advertising pages of the New England Journal of Medicine devoted to advertisements for calcium channel blockers increased from 4. Advertisements for diuretics, on the other hand, were uncommon 4.
In , Wayne Ray and colleagues 60 called for "prospective clinical trials. In another meta-analysis, 19 ACE inhibitors were associated with lower risks of coronary disease or heart failure than calcium channel blockers.
Many commentators now regard calcium channel blockers as second- or third-line agents, 44 although they are still commonly used. In recommending specific classes of drugs as first-line pharmacologic treatments for high BP, the JNC guidelines focused on health benefits demonstrated in large, long-term clinical trials. For older adults, undertreatment of hypertension was common. In the late s, lack of control was primarily characterized by mild to moderate elevations in systolic BP.
More widespread use of low-dose diuretics is likely to be an important public health intervention to prevent the devastating complications of hypertension, including stroke, myocardial infarction, and heart failure. Corresponding author and reprints: Bruce M.
Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy Continue. Figure 1. View Large Download. Veterans Administration Cooperative Study Group on Antihypertensive Agents, Effects of treatment on morbidity in hypertension: results in patients with diastolic blood pressures averaging through mm Hg.
N Engl J Med. J Clin Epidemiol. Br Heart J. Trends in the prevalence of hypertension, antihypertensive therapy, and left ventricular hypertrophy from to Use of antihypertensive drugs and trends in blood pressure in the elderly. All the body's functions depend on arteries channeling oxygen-rich blood - energy - to where it's needed, and smooth muscle cells within these vessels direct how fast or slow the blood gets to each destination.
As smooth muscles contract, they narrow the artery and increase the blood pressure, and as the muscle relaxes, the artery expands and blood pressure falls. If the blood pressure is too low the blood flow will not be enough to sustain a person's body with oxygen and nutrients.
If the blood pressure is too high, the blood vessels risk being damaged or even ruptured.
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