By Norman M. Kaplan
With such a lot of assorted medications on hand for the remedy of the hypertensive sufferer, problems come up as to which medicines are extra efficacious for sufferers. Dr Kaplan information drug regimens from diuretics to ACE inhibitors and to calcium antagonists, no matter if prescribed singly or together. The potent healing use of the medication to be had is obviously provided so the clinician can supply sufferers the fitting remedy
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Additional info for Treatment of hypertension in general practice
However, resistance, defined as a blood pressure above 140/90mmHg despite the use of three or more medications, may occur for a variety of reasons (Table 14). If pseudoresistance is ruled out by out-of-the-office measurements and the patient is adhering to therapy, the most likely reason for true resistance is volume overload from the combination of factors shown in Table 14. Inadequate diuretic therapy, in particular the use of once-a-day furosemide, is the single most common cause of poor control.
6 Hansson L, Zanchetti A, Carruthers SG, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. Lancet 1998;351:1755–1762. 7 UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. BMJ 1998;317:713–720. 8 De Jong PE, Navis G, de Zeeuw D. Renoprotective therapy: titration against urinary protein excretion.
49 Table 15 General guidelines to improve patient adherence to antihypertensive therapy Be aware of signs of patient non-adherence to antihypertensive therapy Establish the goal of therapy: to reduce blood pressure to nonhypertensive levels with minimal or no adverse effects Educate patients about the disease, and involve them and their families in its treatment. Have them measure blood pressure at home Maintain contact with patients; consider telecommunication Keep care inexpensive and simple Encourage lifestyle modifications Integrate pill-taking into routine activities of daily living Prescribe medications according to pharmacological principles, favoring long-acting formulations Be willing to stop unsuccessful therapy and try a different approach Anticipate adverse effects, and adjust therapy to prevent, minimize or ameliorate side effects Continue to add effective and well-tolerated drugs, stepwise, in sufficient doses to achieve the goal of therapy Encourage a positive attitude about achieving therapeutic goals Consider using nurse case management The values of such therapy were portrayed in JNC-6:2 ‘Long-acting formulations that provide 24-hour efficacy are preferred over short-acting agents for many reasons: ■ adherence is better with once-daily dosing; ■ for some agents, fewer tablets incur lower cost; ■ control of hypertension is persistent and smooth rather than intermittent; and ■ protection is provided against whatever risk of sudden death, heart attack and stroke is due to the abrupt increase in blood pressure that occurs after arising from overnight sleep.