Antihypertensives Antihypertensives

Browse our health professional information, resources and educational activities on antihypertensives.

QUM rationale

Drug therapy is the mainstay of treatment in hypertension. Quality use of antihypertensives focuses on ensuring hypertension is managed in the context of all modifiable cardiovascular risk factors.

Presence of co-morbidities should guide selection of antihypertensives. Thoughtful selection of an antihypertensive drug with favourable effects on existing co-morbidities can maximise the benefits of therapy (e.g. ACE inhibitors or angiotensin II-receptor antagonists in diabetes nephropathy), and careful avoidance of an agent with unfavourable effects on existing co-morbidities can minimise harm from therapy (e.g. beta blockers in severe bradycardia). Beta blockers remain under-used in patients with co-morbidities of coronary heart disease or heart failure. In the absence of co-morbidities, low-dose thiazide diuretics have consistent and substantive cardiovascular outcome evidence and remain a good first choice for most patients with uncomplicated hypertension.

Effective use of antihypertensives requires frequent monitoring to achieve target blood pressure, and for most patients, this involves multiple drug therapy. Good communication between the health professional and the patient is required to achieve adherence with therapy.

Key messages from 2007 therapeutic program

• Assess absolute cardiovascular risk and manage hypertension along with other modifiable risk factors
• • use a cardiovascular risk calculator in primary prevention
• When selecting antihypertensive drugs, consider potentially favourable effects on coexisting conditions
• • low-dose thiazides have strong clinical outcome evidence for most populations
  • use beta blockers in people with cardiac disease (heart failure, post-MI, angina)
  • use ACE inhibitors or angiotensin II-receptor antagonists in diabetic nephropathy
• If using a fixed-dose combination product, choose according to the drug components and the dose range available
• • most people require two or more antihypertensive drugs
• Assess adherence with medication and lifestyle changes at every opportunity and intervene if necessary.

Title	Description	Content type	Date*
Olmesartan medoxomil (Olmetec) monotherapy or in combination with hydrochlorothiazide (Olmetec Plus) for hypertension	Reviews use of olmesartan monotherapy or in combination with hydrochlorothiazide for hypertension, including indications for use, drug interactions, and patient monitoring.	NPS RADAR>Review>Health Professional Publication	2007-08-01 00:00:00
Ramipril (Tritace) titration pack	Reviews use of ramipril titration pack for cardiovascular risk reduction, with emphasis on efficient use of tablets for dose titration to 10 mg daily.	NPS RADAR>Review>Health Professional Publication	2003-11-01 00:00:00
Amlodipine with atorvastatin (Caduet) for dyslipidaemia with concomitant hypertension or angina	Reviews use of amlodipine/atorvastatin combination for concurrent dyslipidaemia, hypertension, and angina in comparison with use as single agent therapy.	NPS RADAR>Review>Health Professional Publication	2006-12-01 00:00:00
Additional content: Olmesartan medoxomil monotherapy or in combination with hydrochlorothiazide for hypertension	Table of questions to ask about fixed-dose combination preparations of olmesartan and hydrochlorothiazide for hypertension.	NPS RADAR>Web Only Item>Health Professional Publication	2007-08-01 00:00:00
Who's right about thiazides: ALLHAT or ANBP2?	Reviews and compares the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) and the Second Australian National Blood Pressure Study (ANBP2).	NPS RADAR>Review>Health Professional Publication	2003-01-01 00:00:00
Be aware of dose ranges for new ramipril with felodipine combination (Triasyn) (see erratum below)	A new fixed-dose combination preparation of ramipril with felodipine (Triasyn) was PBS listed with a restricted dose range and dose titration cautions.	NPS RADAR>Brief Item>Health Professional Publication	2007-08-01 00:00:00
Perindopril arginine with indapamide hemihydrate (Coversyl Plus)	Perindopril arginine with indapamide (Coversyl Plus) was PBS listed after a formulation change from perindopril erbumine to perindopril arginine.	NPS RADAR>Brief Item>Health Professional Publication	2007-08-01 00:00:00
Trandolapril 4 mg with verapamil sustained-release 240 mg fixed-dose combination tablet (Tarka) to be listed on PBS	Trandolapril 4 mg with verapamil sustained release 240 mg fixed-dose combination tablet (Tarka) will be listed on the PBS for people already stabilised on antihypertensive treatment who wish to reduce the number of tablets they take each day.	NPS RADAR>Brief Item>Health Professional Publication	2007-04-01 00:00:00
Angiotensin II receptor antagonists: unrestricted PBS listing	Reviews new unrestricted PBS listing of candesartan, eprosartan, irbesartan, and telmisartan for hypertension, heart failure, and diabetic nephropathy.	NPS RADAR>Review>Health Professional Publication	2005-08-01 00:00:00
Change of perindopril (Coversyl) salt from erbumine to arginine	The PBAC has approved the change of perindopril salt from erbumine to arginine, based on bioequivalence of the two formulations. Table of therapeutically equivalent doses included.	NPS RADAR>Brief Item>Health Professional Publication	2006-08-01 00:00:00
Lercanidipine with enalapril (Zan-Extra) fixed-dose combination tablets PBS listed for hypertension	A new fixed-dose combination preparation of lercanidipine with enalapril (Zan-Extra) was PBS listed with a restricted dose range and dose titration cautions.	NPS RADAR>Brief Item>Health Professional Publication	2008-08-01 00:00:00
Moxonidine (Physiotens) for hypertension	Reviews use of moxonidine for hypertension, including combination drug therapy, safety profile, and dosage guidelines.	NPS RADAR>Review>Health Professional Publication	2006-08-01 00:00:00
NPS Prescribing Practice Review 23: Managing hypertension	Information on assessing cardiovascular risk along with lifestyle interventions and drug therapy used in the management of hypertension. Sample feedback prescribing data is also provided.	Prescribing Practice Review - Health Professional Publication	2003-10-07 00:00:00
Guide to selecting antihypertensive drugs in patients with co-existing conditions	Guide outlining which antihypertensive drugs have favourable and which have unfavourable effects on a range of co-existing conditions.	Factsheet - Health Professional	2004-06-01 00:00:00
Cardiovascular risk calculator	A tool to help health professionals assess a patient’s cardiovascular risk and treatment benefit.	Tool - Health Professional	2009-03-12 00:00:00
Case study PH1 report: For pharmacists	Patient reports a persistent cough. She switched from enalapril to irbesartan 3 months ago after suffering a persistent cough. She has type 2 diabetes and hypertension.	Activity - Case Study Report	2000-06-01 00:00:00
Case study 28 report: Managing hypertension in diabetes	Patient with type 2 diabetes presents for review of his blood pressure (145/90 mmHg). His current medications are ramipril, simvastatin and metformin.	Activity - Case Study Report	2003-10-01 00:00:00
Case study 48 report: Achieving tight blood pressure control	Patient diagnosed with hypertension after elevated readings over several months. Family history of cardiovascular disease. Despite adequate trial of lifestyle changes his BP remains elevated.	Activity - Case Study Report	2007-07-01 00:00:00
NPS News 29: Hypertension management to reduce cardiovascular risk	Hypertension management to reduce cardiovascular risk through lifestyle changes and prescribing of thiazides and herbal medicines, with a focus on reducing risk in diabetics.	NPS News - Health Professional Publication	2003-08-01 00:00:00
NPS Prescribing Practice Review 13: Management of hypertension: an update	Information on blood pressure targets, lifestyle interventions, and the role of certain antihypertensives (e.g. low dose thiazides, calcium channel blockers) in the management of hypertension.	Prescribing Practice Review - Health Professional Publication	2001-09-10 00:00:00
NPS News 6: Diagnosis and treatment of hypertension	New guidelines to diagnose and treat hypertension with controversial blood pressure targets recommended. Includes factors to consider in choosing antihypertensive agents.	NPS News - Health Professional Publication	1999-10-01 00:00:00
Case study PH1: For pharmacists	Patient reports a persistent cough. She switched from enalapril to irbesartan 3 months ago after suffering a persistent cough. She has type 2 diabetes and hypertension.	Activity - Case Study	1999-10-01 00:00:00
NPS News 52: Managing hypertension as a cardiovascular risk factor	Pharmacological management of hypertension, with focus on a drug regimen that effectively lowers blood pressure and therefore reduces cardiovascular risk.	NPS News - Health Professional Publication	2007-06-01 00:00:00
Case study 6 report: Management of hypertension	Patient presents for review of his blood pressure which has remained high despite following diet and exercise recommendations. Decision to treat the hypertension is made.	Activity - Case Study Report	2000-01-01 00:00:00
NPS Prescribing Practice Review 38: Managing hypertension as a cardiovascular risk factor	Information on managing hypertension as a cardiovascular risk factor including advice on assessing risk, selecting antihypertensives, lifestyle interventions and encouraging patient compliance.	Prescribing Practice Review - Health Professional Publication	2007-07-01 00:00:00
Case study 48: Achieving tight blood pressure control	Patient diagnosed with hypertension after elevated readings over several months. Family history of cardiovascular disease. Despite adequate trial of lifestyle changes his BP remains elevated.	Activity - Case Study	2007-06-01 00:00:00
Case study 28: Managing hypertension in diabetes	Patient with type 2 diabetes presents for review of his blood pressure (145/90 mmHg). His current medications are ramipril, simvastatin and metformin.	Activity - Case Study	2003-08-01 00:00:00

Useful information from Australian Prescriber

* Information current at date of publication.

Footer