Towards an Evidence Based Treatment Strategy in Hypertension课件.ppt

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Towards an Evidence Based Treatment Strategy in Hypertension课件.ppt

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Towards an Evidence Based Treatment Strategy in Hypertension课件

Refractory Hypertension Failure to control BP with 3-4 drugs including a diuretic. Assess for subtle volume overload Consider 24 hr Ambulatory BP monitor Consider Referral Consider differential diagnosis * * * * * * * * * No significant difference was observed between amlodipine (the red line) and chlorthalidone (the blue line) for the primary outcome. The relative risk for amlodipine compared to chlorthalidone was 0.98, with a 95% confidence interval of 0.90-1.07. Also, no significant difference was observed between lisinopril (the green line) and chlorthalidone for the primary outcome. The relative risk was 0.99, with a 95% confidence interval of 0.91-1.08. * * The results for the primary endpoint were consistent across the pre-defined subgroups, as shown here, as well as for participants with and without CHD at baseline. * * * * Slide ID: 5888 Slide Summary Achieving optimal blood pressure (BP) control generally requires combination therapy, eg, more than 1 antihypertensive agent. Key Clinical Information In most recent major, large-scale clinical hypertension trials, more than 2 antihypertensive agents were required to achieve predefined BP goals1-4 Data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) indicated that most patients will need multidrug therapy to get to goal2,5 The lower the BP goal, the greater the number of antihypertensive agents generally required2 Bakris GL, Williams M, Dworkin L, et al, for the National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group. Preserving renal function in adults with hypertension and diabetes: a consensus approach. Am J Kidney Dis. 2000;36:646-661. Cushman WC, Ford CE, Cutler JA, et al, for the ALLHAT Collaborative Research Group. Success and predictors of blood pressure control in diverse North American settings: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). J Clin Hypertens (Greenwich). 2002