Treating hypertension to prevent coronary disease
Donald G. Vidt, MD
Alan Bakst, PharmD
Norman M. Kaplan, MDAddress reprint requests to N.M.K., Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75235-8899.
Because most patients with mild to moderate hypertension will not suffer a cardiovascular event due to elevated blood pressure, the presence of other risk factors must be assessed. Many of these are alterable with nondrug therapies, which cost little and carry no risks if applied sensibly. Drug therapies have costs, discomforts, and risks and should be used only for those at high risk or those who fail to respond adequately to nondrug therapies. When drug therapy is necessary, start with low doses and aim for a slow reduction of blood pressure, avoiding hypoperfusion and reducing as many risk factors as possible. Alpha blockers, angiotensin-converting enzyme inhibitors, and calcium-channel blockers may avoid metabolic risks associated with high-dose diuretic and beta-blocker therapy. The establishment of therapeutic goals, individualized assessment of status, and a conservative approach to treatment are the basis for optimal management of patients with hypertension.