Treating stage 2 hypertension

Abstract

The prevalence of hypertension increases with advancing age, due primarily to increases in systolic blood pressure. Systolic hypertension is the most common form of hypertension in individuals over 50 years of age and reflects pathologic decreases in arterial compliance. Systolic blood pressure elevation is a more important risk factor for cardiovascular disease than is diastolic blood pressure elevation. Stage 2 hypertension, defined as blood pressure > or =160/100 mm Hg, is often found in older persons, who are at highest risk for cardiovascular events. In this clinical review, hypertension experts utilize a case study to provide a paradigm for treating older patients with stage 2 hypertension.

Figure 1

Algorithm for the treatment of hypertension. SBP=systolic blood pressure; DBP=diastolic blood pressure; ACEl=angiotensin‐converting enzyme inhibitor; ARB=angiotensin receptor blocker; βB=β blocker; CCB=calcium channel blocker. Reproduced with permission from Hypertension. 2003;42:1206–1252.⁴

Figure 2

Reductions in 24‐hour ambulatory systolic blood pressure (SBP) in the intent‐to‐treat population in a comparison of a fixed‐dose combination (amlodipine besylate—benazepril HCl) with either of its two components. δ=change; *p<0.0001 for combination vs. both other treatments