Med. praxi 2012; 9(6-7): 262-265

A hypertensive patient in the general practitioner's surgery

MUDr.Jan Václavík, Ph.D.
Centrum pro hypertenzi, I. interní klinika &ndash, kardiologická, LF UP a FN Olomouc

The article briefly summarizes recent knowledge regarding the diagnosis and treatment of hypertension. Correct diagnosis of hypertension

requires repeated ambulatory and home blood pressure measurements and a more frequent use of ambulatory blood pressure

monitoring, particularly in younger patients. Non-pharmacological measures can significantly reduce blood pressure and should be

applied to all patients. To achieve target blood pressure levels, most patients require the use of a combination of several antihypertensive

drugs, ideally in the form of fixed combinations that reduce blood pressure more effectively, improve patient adherence to treatment,

and are frequently associated with lower rates of adverse effects.

Keywords: hypertension, diagnosis, treatment, non-pharmacological measures, combination therapy, fixed combination

Published: August 1, 2012  Show citation

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Václavík J. A hypertensive patient in the general practitioner's surgery. Med. praxi. 2012;9(6-7):262-265.
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References

  1. Cífková R, Bruthans J, Adámková V, et al. Prevalence základních kardiovaskulárních rizikových faktorů v české populaci v letech 2006-2009. Studie Czech post-MONICA. Cor Vasa 2011; 53: 220-229. Go to original source...
  2. Widimský J Jr, Cífková R, Špinar J, et al. Doporučení diagnostických a léčebných postupů u arteriální hypertenze - verze 2007. Doporučení České společnosti pro hypertenzi. Vnitř Lék. 2008; 54(1): 101-118. Go to PubMed...
  3. Myers MG, Godwin M, Dawes M, et al. Conventional versus automated measurement of blood pressure in primary care patients with systolic hypertension: randomised parallel design controlled trial. BMJ. 2011; 342: d286. Go to original source... Go to PubMed...
  4. Powers BJ, Olsen MK, Smith VA, et al. Measuring blood pressure for decision making and quality reporting: where and how many measures? Ann Intern Med. 2011 21; 154(12): 781-788, W-289-290. Go to original source... Go to PubMed...
  5. British Hypertension Society Guidelines. Hypertension: Clinical management of primary hypertension in adults. http://www.nice.org.uk/guidance/CG127.
  6. Hodgkinson J, Mant J, Martin U, et al. Relative effectiveness of clinic and home blood pressure monitoring compared with ambulatory blood pressure monitoring in diagnosis of hypertension: systematic review. BMJ. 2011 24; 342: d3621. Go to original source... Go to PubMed...
  7. Lovibond K, Jowett S, Barton P, et al. Cost-effectiveness of options for the diagnosis of high blood pressure in primary care: a modelling study. Lancet. 2011, 1; 378(97-98): 1219-1230. Go to original source... Go to PubMed...
  8. Neter JE, Stam BE, Kok FJ, Grobbee DE, Geleijnse JM. Influence of weight reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension. 2003; 42(5): 878-884. Go to original source... Go to PubMed...
  9. Cornelissen VA, Fagard RH. Effects of endurance training on blood pressure, blood pressure-regulating mechanisms, and cardiovascular risk factors. Hypertension. 2005; 46(4): 667-675. Go to original source... Go to PubMed...
  10. Dickinson HO, Mason JM, Nicolson DJ, Campbell F, Beyer FR, Cook JV, Williams B, Ford GA. Lifestyle interventions to reduce raised blood pressure: a systematic review of randomized controlled trials. J Hypertens. 2006; 24(2): 215-233. Go to original source... Go to PubMed...
  11. Dickerson JE, Hingorani AD, Ashby MJ, Palmer CR, Brown MJ. Optimisation of antihypertensive treatment by crossover rotation of four major classes. Lancet. 1999 12; 353(9169): 2008-2013. Go to original source... Go to PubMed...
  12. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, Narkiewicz K, Ruilope L, Rynkiewicz A, Schmieder RE, Boudier HA, Zanchetti A. ESH-ESC Task Force on the Management of Arterial Hypertension. 2007 ESH-ESC Practice Guidelines for the Management of Arterial Hypertension: ESH-ESC Task Force on the Management of Arterial Hypertension. J Hypertens. 2007; 25(9): 1751-1762. Go to original source... Go to PubMed...
  13. Wald DS, Law M, Morris JK, Bestwick JP, Wald NJ. Combination therapy versus monotherapy in reducing blood pressure: meta-analysis on 11,000 participants from 42 trials. Am J Med. 2009; 122(3): 290-300. Go to original source... Go to PubMed...
  14. Gradman AH, Acevedo C. Evolving strategies for the use of combination therapy in hypertension. Curr Hypertens Rep. 2002; 4(5): 343-349. Go to original source... Go to PubMed...
  15. Brown MJ, McInnes GT, Papst CC, et al. Aliskiren and the calcium channel blocker amlodipine combination as an initial treatment strategy for hypertension control (ACCELERATE): a randomised, parallel-group trial. Lancet. 2011 22; 377(9762): 312-320. Go to original source... Go to PubMed...
  16. Neldam S, Lang M, Jones R, et al. Telmisartan and Amlodipine Single-Pill Combinations vs Amlodipine Monotherapy for Superior Blood Pressure Lowering and Improved Tolerability in Patients With Uncontrolled Hypertension: Results of the TEAMSTA-5 Study. J Clin Hypertens (Greenwich). 2011; 13(7): 459-466. Go to original source... Go to PubMed...
  17. Corrao G, Nicotra F, Parodi A, Zambon A, Heiman F, Merlino L, Fortino I, Cesana G, Mancia G. Cardiovascular protection by initial and subsequent combination of antihypertensive drugs in daily life practice. Hypertension. 2011; 58(4): 566-572. Go to original source... Go to PubMed...
  18. Mancia G, Laurent S, Agabiti-Rosei E, Ambrosioni E, Burnier M, Caulfield MJ, Cifkova R, Clément D, Coca A, Dominiczak A, Erdine S, Fagard R, Farsang C, Grassi G, Haller H, Heagerty A, Kjeldsen SE, Kiowski W, Mallion JM, Manolis A, Narkiewicz K, Nilsson P, Olsen MH, Rahn KH, Redon J, Rodicio J, Ruilope L, Schmieder RE, Struijker-Boudier HA, van Zwieten PA, Viigimaa M, Zanchetti A. European Society of Hypertension. Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document. J Hypertens. 2009; 27(11): 2121-2158. Go to original source... Go to PubMed...
  19. Dahlöf B, Sever PS, Poulter NR, Wedel H, Beevers DG, Caulfield M, Collins R, Kjeldsen SE, Kristinsson A, McInnes GT, Mehlsen J, Nieminen M, O'Brien E, Ostergren J. ASCOT Investigators. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomized controlled trial. Lancet 2005; 366: 895-906. Go to original source... Go to PubMed...
  20. Williams B, Lacy PS, Thom SM, Cruickshank K, Stanton A, Collier D, Hughes AD, Thurston H, O'Rourke M. CAFE Investigators; Anglo-Scandinavian Cardiac Outcomes Trial Investigators; CAFE Steering Committee and Writing Committee. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation. 2006 7; 113(9): 1213-1225. Go to original source... Go to PubMed...
  21. Rothwell PM, Howard SC, Dolan E, O'Brien E, Dobson JE, Dahlöf B, Sever PS, Poulter NR. Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet. 2010 13; 375(9718): 895-905. Go to original source... Go to PubMed...
  22. Jamerson K, Weber MA, Bakris GL, Dahlöf B, Pitt B, Shi V, Hester A, Gupte J, Gatlin M, Velazquez EJ. ACCOMPLISH Trial Investigators. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med 2008; 359: 2417-2428. Go to original source... Go to PubMed...
  23. Fung V, Huang J, Brand R, Newhouse JP, Hsu J. Hypertension treatment in a medicare population: adherence and systolic blood pressure control. Clin Ther. 2007; 29(5): 972-984. Go to original source... Go to PubMed...
  24. Bangalore S, Kamalakkannan G, Parkar S, Messerli FH. Fixed-dose combinations improve medication compliance: a meta-analysis. Am J Med. 2007; 120(8): 713-719. Go to original source... Go to PubMed...
  25. Dickson M, Plauschinat CA. Compliance with antihypertensive therapy in the elderly: a comparison of fixed-dose combination amlodipine/benazepril versus component-based free-combination therapy. Am J Cardiovasc Drugs. 2008; 8(1): 45-50. Go to original source... Go to PubMed...
  26. Destro M, Luckow A, Samson M, Kandra A, Brunel P. Efficacy and safety of amlodipine/valsartan compared with amlodipine monotherapy in patients with stage 2 hypertension: a randomized, double-blind, multicenter study: the EX-EFFeCTS Study. J Am Soc Hypertens. 2008; 2(4): 294-302. Go to original source... Go to PubMed...
  27. Littlejohn TW 3rd, Majul CR, Olvera R, Seeber M, Kobe M, Guthrie R, Oigman W. Study Investigators. Results of treatment with telmisartan-amlodipine in hypertensive patients. J Clin Hypertens (Greenwich). 2009; 11(4): 207-213. Go to original source... Go to PubMed...
  28. Oparil S, Melino M, Lee J, Fernandez V, Heyrman R. Triple therapy with olmesartan medoxomil, amlodipine besylate, and hydrochlorothiazide in adult patients with hypertension: The TRINITY multicenter, randomized, double-blind, 12week, parallel-group study. Clin Ther. 2010; 32(7): 1252-1269. Go to original source... Go to PubMed...




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