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Frequently Asked Questions

What are the recommended drugs to be used for the treatment of hypertension in elderly?

Hypertension in the elderly is mainly systolic. Trials especially addressing treatment of isolated systolic hypertension have shown the benefits of thiazides and calcium channels blockers (CCBs). Certain trials like LIFE showed the advantages of angiotensin receptors blockers (ARBs) in the treatment of hypertension in elderly, especially in patients with left ventricular hypertrophy (LVH).

What is the recommended target blood pressure (BP) to be reached in diabetic hypertensive patients?

The recommended target blood pressure in diabetic hypertensive patients is

How should hypertension associated with metabolic syndrome be managed?

In all individuals with metabolic syndrome, intense lifestyle measures should be adopted. When there is hypertension, drug treatment should start with a drug unlikely to facilitate onset of diabetes. Therefore a blocker of the renin-angiotensin system should be used followed, if needed, by the addition of a calcium antagonist or a low dose of thiazide diuretic.

Why do some patients with hypertension seem to be resistant to treatment?

Resistant hypertension is seen quite frequently in clinical practice and the possible causes include: poor adherence to the therapeutic plan, failure to modify lifestyle including weight gain, continued intake of drugs that raise blood pressure, obstructive sleep apnea, unsuspected secondary cause, irreversible or scarcely reversible organ damage and volume overload due to inadequate diuretic therapy, progressive renal insufficiency, high sodium intake, and hyperaldosteronism.

How should resistant hypertension be managed?

Resistant hypertension can be managed by careful elicitation of the history, a meticulous examination and good investigational take up. Ambulatory blood pressure monitoring is recommended. Test whether compliance is good or not. Administration of more than 3 drugs. Use of aldosterone antagonists in low doses. Use of endothelin antagonists (investigational). Interventional therapy includes chronic field stimulation of carotid sinus nerves and renal artery denervation.

How many hypertensive patients achieve target blood pressure?

Several large-scale population-based studies in different parts of the world indicate that only 25-30% of hypertensive patients actually achieve target blood pressure with life style and medicinal measures.

Which are the major causes of inadequate blood pressure control?

Inadequate blood pressure control is due to a number of factors related to misdiagnosis, doctor-and-patient related causes. The most important causes are improper blood pressure recording techniques, physician inertia, and patient non-compliance to therapy.

Which percentage of hypertensive patients requires more than one drug to achieve target blood pressure?

Several large-scale international studies show that more than 75% of patients require more than one drug to achieve target blood pressure.

Which combinations of antihypertensive drug classes are preferred combinations in the ESH/ESC 2007/2009 guidelines?

Various combinations can be preferred. They include thiazide diuretics with angiotensin converting enzyme (ACE) inhibitors, angiotentin receptor blockers (ARBs) or dihydropyridines; dihydropyridines with ACE-inhibitors, ARBs or beta-blockers.

What are the advantages of the use of fixed dose combinations in the treatment of hypertension?

The major advantages of the use of fixed dose combinations are: (1) they improve patient compliance to antihypertensive therapy; (2) they improve the degree of blood pressure control; (3) they reduce the number of adverse events.