Pharmacologic Treatment

® An approach to selection of drugs for the treatment of patients with hypertension should be evidence-based with considerations regarding the individual's coexisting disease states, coprescribed medications, and practical patient-specific issues including cost. The JNC 7 report and statements from other global organizations recommend drug therapy that is largely grounded in the best available evidence for superiority in outcomes—specifically morbidity and mortality.1 The approach is often tempered with practical considerations related to competing options for specific comorbidities and issues regarding a patient's experience or tolerance for side effects, and in some cases, the cost of medications.

Although landmark trials, such as the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT), have provided some objective basis for comparisons between initiating antihypertensive drug therapy with one class of

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antihypertensives versus another, there is room for criticism of these studies. Consequently, practical interpretations of their conclusions must always leave room for individualization based on clinical judgment. Overall current clinical guidelines provide a reasonable basis for guiding the selection of drug classes for individuals based on their stage of hypertension, comorbidities, and special circumstances. The following section will summarize key features of specific drug classes and guideline recommendations for patients with hypertension. Finally, an overview of the specific oral antihypertensive drug classes in common use is summarized in Table 5-4.

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