Pharmacotherapy for Hypertension

Numerous clinical trials have demonstrated that antihy-

pertensive pharmacotherapy generally reduces the risk of

hypertension-associated complications (e.g., CV morbidity

and mortality).» This evidence is the foundation for the 2003

JNC7 and 2007 AHA consensus guidelines, which recommend

specific evidence-based pharmacotherapy recommendations

based on patient-specific medical history and CV risk (Fig.

13-3).

As is recommended in the 2007 AHA guidelines, evidence

supports the use of an ACEI, ARB, calcium channel blocker

(CCB), thiazide diuretic, or a two-drug combination for first-

line therapy for primary prevention patients.9,20 This is in con-

trast to the 2003 JNC7 guidelines that placed preference on us-

a ing a thiazide diuretic over other agents for most patients, and

also included a -blocker as a potential first-line option.' Evi-

dence obtained since the 2003 JNC7 guidelines demonstrates,

however, that, for first-line treatment in primary prevention

patients, -blocker therapy is not as effective in reducing CV

events compared with ACEI, ARB, CCB, or thiazide diuretic

therapy.- Moreover, newer evidence also suggests that the re-

ductions in CV events with ACEI, ARB, CCB, or thiazide

diuretic are comparable so that one agent is not automatically

preferred over another.

Pharmacotherapy has been evaluated in patients with

one of several comorbid conditions considered compelling

indications for specific pharmacotherapy. The selection of

pharmacotherapy in such patients is much more prescriptive

than in primary prevention patients, and is outlined in Figure

13-3. These recommendations are based on evidence demon-

strating reduced risk of CV events in patients with both hyper-

tension and the compelling indication.