Drug Treatment of Hypertension: Initiating Drug Therapy
Initiating drug therapy (management strategies)
At our institution, we take the following approach. In the absence of specific indications or contraindications, the choice of the first-line drug is tailored to the patient’s clinical characteristics based on its expected efficacy and potential side effects.
If unacceptable side effects are experienced, other drugs are substituted. If a first-line drug is well tolerated but ineffective, second and third agents may be substituted or added to the initial choice depending on the severity of the patient’s hypertension, the degree of response to the first drug, and the possibility of synergism between added drugs (eg, diuretic and angiotensin-converting enzyme (ACE) inhibitor).
When triple therapy fails to control hypertension, the clinician must look for reasons.
• Is the patient not complying with the prescribed regimen, perhaps because of cost, lack of dosing convenience, or side effects?
• Is there poor compliance with non-pharmacologic instructions (such as diet)?
• Are reflex physiologic changes occurring as a consequence of the antihypertensive drug initially prescribed that may attenuate the hypertensive response (eg, reflex sympathetic stimulation or sodium or water retention secondary to vasodilator therapy)?
• Is there an underlying secondary cause of hypertension?
This post has been viewed 6212 times.
Comments are closed.
