Drug Rx Considerations

Possible future treatments for resistant hypertension include catheter-based radiofrequency ablation of the renal sympathetic nerves and surgically implanted carotid baroreceptor stimulators.

Sexual dysfunction is a common complaint in patients taking antihypertensive drugs. Other causes should be considered. Both normotensive men and women have increase in sexual dysfunction with age. Hypertensive patients have a higher prevalence of sexual dysfunction compared to normal controls. Carefully controlled trials, however, show little, if any, additional effect of antihypertensive drugs on sexual dysfunction. This is in contrast to the large body of uncontrolled and anecdotal data that attributes sexual dysfunction to these drugs.

Alternative drugs may be selected for initial therapy because of associated conditions. For example, in patients with diabetes or heart failure an ACE inhibitor, angiotensin II receptor blocker or direct renin inhibitor may be chosen. On the other hand, these drugs are contraindicated in pregnancy.

In some patients, medications may be reduced or discontinued if lifestyle modification is successful. That is, their blood pressure remains normal on no drug therapy for at least six months. Even then, close long term follow-up is indicated, as many patients return to their old lifestyle habits. The result is a return of their hypertension.

In the management of hypertension, a stepwise approach should be followed when making changes in drug dosage, substitution of a drug or adding a drug. This will help to avoid confusion regarding what change has resulted in a given therapeutic effect or a side effect.