Modern strategies to prevent coronary sequelae and stroke in hypertensive patients differ from the jnc v consensus guidelines

Louis Tobian, Hans R. Brunner, Jay N. Cohn, Haralambos Gavras, John H. Laragh, Barry J. Materson, Michael A. Weber

Research output: Contribution to journalArticlepeer-review

42 Scopus citations

Abstract

In recent years, government agencies of many countries have established consensus guidelines for the evaluation and treatment of hypertension. Once published, guidelines tend to be perceived as directives by a variety of ealth care providers. Unfortunately, these guidelines often do not reflect the practices of most hypertension experts. This report summarizes the opinions of seven hypertension experts concerning the impact of "official" guidelines on clinical practice. In addition, the individual therapeutic recommendations of these panel members are summarized. Their different treatment strategies reflect the diversity of first rate treatment plans that aim to reduce the cardiovascular sequelae in individual patients with essential hypertension. Most importantly, not one of these seven treatment strategies followed the "preferred" treatment of the U.S. guidelines, which recommend diuretics and β-blockers as first-line therapy. The present authors approach the treatment of hypertension as a means to reduce cardiovascular events. Thus, reduction of blood pressure is not the most important therapeutic endpoint. The panel believes that whereas many different drugs can produce effective blood pressure reduction, the modern primary goal of antihypertensive drug therapy is to select a regimen most likely to prolong the quality and duration of life. In real terms, this means that the primary goal of treatment is the prevention of the major vascular sequelae of hypertension (heart attack, ventricular remodeling, hypertrophy, heart failure, and stroke) that shorten useful life. There are a number of effective hypertensive treatments, which can be selected based on individual patient requirements. However, many consensus guidelines do not allow the flexibility required to optimize individual patient treatment. As a result, health care providers should not feel compelled to regard the preferences of "official" guidelines as the best, modern, state-of-the-art therapy for an individual patient. All seven experts who are deeply involved in the daily care of patients preferred drugs other than β-blockers and diuretics (the Joint National Committee [JNC] choices) for first-line therapy of hypertension.

Original languageEnglish (US)
Pages (from-to)859-872
Number of pages14
JournalAmerican journal of hypertension
Volume7
Issue number10
DOIs
StatePublished - 1991

Keywords

  • Diuretics
  • First-line therapy
  • Government guidelines
  • Hypertension treatment
  • JNC V
  • β-blockers

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