Antihypertensives Antihypertensives

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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.

Resources

* Information current at date of publication.

Useful information from Australian Prescriber

* Information current at date of publication.

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