Hypertension is the most prevalent form of cardiovascular disease. It affects 1 in 4 adults in the United States. Many of these individuals are asymptomatic. A specific cause of hypertension can be identified in only 10% to 15% of the patient population.1 Typically, the risk of developing hypertension is associated with certain factors. Examples of these risk factors include the following:
Sustained arterial hypertension damages the blood vessels in the kidneys, heart, and brain and can ultimately lead to an increased incidence of renal failure, coronary disease, cardiac failure, retinopathy, and stroke.1 With proper treatment, the risks for developing these complications can be significantly decreased, thus reducing the rates of mortality and morbidity.
On May 14, 2003, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (the JNC 7 Report) provided the classifications of blood pressure.2 These are outlined in Table 1.
Once hypertension is diagnosed, proper treatment should be established. The degree of blood pressure, age, gender, other existing medical conditions, and concurrent medication profile should be evaluated prior to initiating any therapy. Nonpharmacologic therapies, such as lifestyle modifications in diet and activity, may also be incorporated into the treatment plan. Currently, there are a variety of pharmacologic agents available to treat hypertension. Many agents are manufactured by various pharmaceutical companies in generic formulations as therapeutic equivalents to brand name products as established by the FDA. The various pharmacologic classes of antihypertensives can be classified into the following broad categories according to their principal regulatory site or mechanism of action1:
The individual pharmacologic classes that are available in generic formulations are listed in Table 2.
The JNC 7 guidelines recommend thiazide diuretics as the first line of therapy for treating most patients with hypertension, either alone or in combination with other antihypertensives, when possible.2 If a drug is not tolerated or is contraindicated, many other choices are available. Quite often, another agent needs to be added to reach a desired therapeutic effect for treating hypertension. Many antihypertensives are available as combination formulations as well. Once therapy is initiated, patients should receive routine monitoring, and medications should be adjusted accordingly until blood pressure goals are attained.
Ms. Terrie is a clinical pharmacy writer based in the northern Virginia area.
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