Current Medical Treatments For Hypertension

Hypertensive drugs are normally taken on a continuous basis.9 In diseases such as hypertension, diabetes, and asthma, a relapse following cessation of treatment is considered evidence of the effectiveness of the treatment and the need to continue monitoring the patient.32 The six main drug treatments for hypertension are diuretics, beta-blockers, calcium antagonists, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II antagonists, and alpha-adrenergic blockers, although no reliable data support the last two regimens.23

Beta-blockers interfere with the absorption of epinephrine, leading to decreases of heart rate and blood pressure, although caffeine, alcohol, and salt can reverse the effects.8 Furthermore, an increase of triglycerides may result from the use of beta-blockers.33,34 Diuretics may impair lipid profile, cause glucose intolerance, and result in elevation of uric acid.33 Resperpine and methyldopa are also used in some parts of the world. Aspirin is used as an antiplatelet therapy.23

Possible new drugs are constantly on trial, for instance, vasopeptidase inhibitors.9 Sildenafil specializes in pulmonary vasodilation; while it increases blood flow out of the heart, it has no effect on wedge pressure.35 One group of researchers attempted to determine whether benazepril or nitrendipine produced a "greater reduction in left ventricular mass." The results were close: benazepril had greater effect on diastolic pressure and nitrendipine decreased systolic pressure more.32

Keeping in mind the terrible risks the disease involves, some people with high blood pressure do not feel any warning signs and thus fail to realize they have a major illness.9 They feel fine and the treatments are expensive and cause uncomfortable side effects. Thus, only 24% of patients with hypertension in the U.S. are adequately treated.7 Discontinuation of treatments and switching therapies increase the costs of patient care.4 In the U.S., nearly 75% of patients with hypertension are poorly controlled, and the number is higher in other countries.4 Tolerability of drug treatment is an important influence; some patients may consider their hypertensive medications more troublesome than the seemingly symptomless disease and stop taking their medications.16

Attention is now paid to health-related quality of life (HR-QOL) issues in health services. The most common areas of inquiry on patient-completed questionnaires are cognitive function, symptomatic well-being, adverse effects, sexual function, psychological well-being, sleep dysfunction, social participation, and general health perception.16 A recent goal of treatment for hypertension, in addition to lowering blood pressure, is to reduce the adverse side effects of medications in order to increase patient compliance.33 Side effects include nausea, vomiting, muscle twitching, headaches, flushing, hypotension, tachycardia, aggravation of angina pectoris, hyperglycemia, renal failure, bowel and bladder paresis, blurred vision, dry mouth, bronchoconstriction, heartblock, drowsiness, and increased risk of glaucoma.15

The comorbidity rate of hypertension with other diseases, the effects of hypertension medications on symptoms, and the effects of the medications for the other diseases on hypertension further increase the adverse side effects and the probability of noncompliance with drug therapy. No single class of hypertensive medication meets the requirements of an ideal drug therapy.33 Patients clearly have a need to be educated about hypertension therapy in order to increase compliance with prescribed treatments.1 Greater numbers of television and magazine advertisements urging people with high blood pressure to continue to take their medications and to stay in contact with their doctors, even if they feel fine, are attempts to meet this need.

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