Chapter 5. Treatment with antihypertensive drugs.

摘要

POINT 5A 1.The preventive effects of antihypertensive drugs on cardiovascular disease are determined by the degree to which blood pressure decreases rather than its class.2.The antihypertensive drug to be first administered alone or concomitantly with other drugs should be selected from Ca channel blockers, angiotensin-receptor blockers (ARBs), angiotensin-converting enzyme (ACE) inhibitors, diuretics and β-blockers.3.Appropriate antihypertensive drugs should be selected considering positive indications, contraindications, conditions that require the careful use of drugs and the presence or absence of complications.4.Antihypertensive drugs are administered once a day, in principle, but as it is more important to control the blood pressure over 24 h, splitting the dose into twice a day is desirable in some situations.5.The use of two or three drugs in combination is often necessary to achieve the target of blood pressure control. A low dose of a diuretic should be included in this combination.6.Among the combinations of two drugs, those of a renin-angiotensin (RA) system inhibitor (ARB or ACE inhibitor)+Ca channel blocker, RA system inhibitor+diuretic, Ca channel blocker+diuretic and Ca channel blocker+beta-blocker are recommended.7.Simplification of the prescription using fixed-combination drugs is useful for improving adherence and controlling blood pressure.8.A gradual reduction in blood pressure is desirable in hypertensive patients in general, particularly in elderly patients, but the target control level should be achieved within a few weeks in high-risk patients, such as those with grade III hypertension and multiple risk factors.