The Singapore Family Physician
Back to issue Vol 37 No. 4 - Cardiometabolic Risk Update
Rethinking the Strategies in Hypertension Management
The Singapore Family Physician Vol 37 No 4 - Cardiometabolic Risk Update
35 - 39
1 October 2011
The prevalence rates of hypertension are expected to increase globally. Hypertension accounts for the majority of stroke and at least half of heart attacks. Blood pressure lowering results in significant reduction in coronary artery disease events and stroke. Therapeutic intervention in high normal blood pressure delays the onset of hypertension but its long term benefits are uncertain. In hypertension with co-morbidities, the lower achievable blood pressure may not be better in view of concerns over the J curve effect of excessive blood pressure reduction. Hypertension predisposes to the onset of diabetes which may be accelerated by certain classes of anti-hypertensive agents, namely diuretics or beta-blockers. In the very elderly, the cardiovascular benefits of blood pressure lowering can be substantial. Improved cardiovascular outcomes are achieved by combination therapies which have clearly demonstrated pronounced blood pressure lowering and higher control rates. Certain drug components of the combination therapy may be preferred to improve cardiovascular outcomes. Dual renin-angiotensin aldosterone system blockade should not be routinely used but is indicated for hypertensive patients without heart severe heart failure or chronic renal disease with heavy proteinuria. The many advantages of single pill combination therapy will improve the overall management of hypertension.