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Chapter-101 Hypertension Paradoxes

BOOK TITLE: CSI: Cardiology Update 2014

Author
1. Hiremath Jagdish S
2. Sheth Kaushik
ISBN
9789351526186
DOI
10.5005/jp/books/12415_102
Edition
1/e
Publishing Year
2015
Pages
2
Author Affiliations
1. Poona Hospital and Research Centre, Pune, Maharashtra, India, Ruby Hall Clinic, Pune, Maharashtra, India
2. Ruby Hall Clinic, Pune, Maharashtra, India
Chapter keywords
Angiotensin-converting-enzyme, CCBs and diuretics, low-dose combination therapy, hypertension paradoxes, triple combination pills

Abstract

The prevalence of hypertension in the last six decades has increased from 2% to 25% among urban residents and 1% to 15% among rural residents of India. Antihypertensive therapy aims to abolish the risks associated with hypertension without adversely affecting quality of life. It has reduced the incidence of stroke by 35– 40%, coronary events by 20–25% and congestive cardiac failure by 50% in placebo controlled trials. All classes of antihypertensive drugs are equally effective, though the choice of initial drug is based on other compelling indication. Goal of treatment is to prevent the progression from risk to disease to event (HTN → Atherosclerosis → CV events). In “step care” approach, one antihypertensive agent is started and its dose is increased up to maximum tolerated dose. Combination of agents should be based on drugs that affect different mechanisms of BP and also that prevent activation of counter-regulatory mechanism [renin-angiotensin-aldosterone system (RAAS) activation by diuretics prevented by ACE inhibitors]. Combination therapy also avoids dose dependent side effects as required doses are lesser. Advantages of low-dose combination therapy and hypertension paradoxes are discussed.

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