Drug Rx Considerations

The choice of drug therapy requires several important considerations. These include the blood pressure level, target organ damage, and the presence of concomitant diseases and risk factors. It also includes the age and race of the patient, contraindications for specific drugs, quality of life and cost. Adherence can be improved with the use of one drug or a single fixed-dose combination given once daily.

Age and ethnicity interactions are important determinants of a patient's response to single-drug therapy. Elderly patients generally respond well to all classes of drugs. They are more likely to have isolated systolic hypertension, associated with an increased risk of cardiovascular and cerebrovascular events. These patients should be treated, preferably with a diuretic or calcium antagonist. African american patients are often less responsive to beta blockers and drugs that block the renin-angiotensin-aldosterone system when used alone, but they respond well to combination therapy.

Initial drug treatment for stage 1 uncomplicated hypertension is monotherapy with a thiazide-type diuretic, ACE inhibitor, angiotensin receptor blocker or calcium antagonist. Patients with stage 2 hypertension and patients whose blood pressure goals are lower because they have diabetes or chronic renal disease, often require multiple drug therapy. Combining agents in a single pill can be useful, since it has been shown to enhance patient adherence. If blood pressure is greater than 20/10 mmHg above goal, consider combination therapy initially. The majority of hypertensive patients still require two or more drugs to achieve goal blood pressure.