PMID: 9534090Apr 16, 1998Paper

Antihypertensive treatment: past, present and future

Journal of Hypertension. Supplement : Official Journal of the International Society of Hypertension
G Mancia, G Grassi

Abstract

Guidelines for pharmacological and non-pharmacological approaches to the treatment of hypertension were first published in 1977 and were subsequently revised in the 1980s. They were largely based on the approach known as 'stepped care', which suggests that antihypertensive treatment should be started with the initial use of a thiazide diuretic, followed by the addition of a second, third and fourth drug if no satisfactory therapeutic success is obtained. This approach was reviewed in the guidelines that followed, which indicated that pharmacological treatment should be started in a more liberal fashion by selecting the antihypertensive drug from among four rather than two classes (diuretics, beta-blockers, angiotensin converting enzyme inhibitors and calcium antagonists). The latest guidelines issued in 1993 by the World Health Organization/International Society of Hypertension and by the Joint National Committee contain innovative aspects on how to treat high blood pressure. They share common features, such as lifelong treatment of hypertension, attention to overall cardiovascular risk profile, initiation of treatment with lifestyle changes and subsequently with monotherapy, but they also have differences, such as goal blood p...Continue Reading

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