P. Aranda

Diuretics and the treatment of systemic hypertension

Diuretics are still among the most frequently used antihypertensive drugs in the treatment of hypertension. Their pharmacologic and hemodynamic properties are based on the water and salt metabolism in the pathophysiology of high blood pressure. Initially, there is a reduction of plasma and extracellular fluid volume; cardiac output also decreases. After this early phase, cardiac output returns to normal with an accompanying decrease in peripheral resistance so as to correct the underlying hemodynamic fault of the hypertensive state. Diuretics have a high therapeutic efficacy either as monotherapy or in combination with beta blockers, angiotensin-converting enzyme inhibitors or calcium antagonists. The main problem with the use of diuretics is related to their metabolic side effects, which are dose-related. Currently, there is a tendency to administer low-dose diuretics, which result in fewer clinical and metabolic side effects, but with a continued antihypertensive efficacy. Therefore, low doses of diuretics can be recommended as initial therapy in the stepped-care approach of hypertension.

M.446 Assessing the real cardiovascular risk of treated essential hypertensive population. Are we doing well

In a cross-sectional, nation-wide survey, we evaluated the cardiovascular risk profile of treated essential hypertensive population through the application of the prognostic risk stratification chart proposed by the 1999 WHO / ISH committee. The study was performed at Primary Care setting by assessing clinical reports of 1038 (52.12% females) treated essential hypertensives with a mean age: 59.7 12.2 years, mean BMI: 27.4 4; mean BP:142.1 15 / 85.8 10 mmHg and mean PP: 56.3 12.5 mmHg. Antihypertensive drugs received by patients (%): One: 46.82; Two: 32.76%; Three: 13.49, and 4 or more: 5,97 %. 472 (45.5%) patients had dyslipidemia, but only 322 (31.02%) were receiving statins, and 194 (18.69%) antiplatelet drugs. Considering the levels of BP: 36.42 % had Mild; 50.4% Moderate and 13.10% severe HTN. On the other hand, 10.02% had no other risk factors (RF); 33.70 % had 1 or 2 RF; 3 or more RF or diabetes or TOD had 25.63 %, and CV complications 31.80%. According to the WHO / ISH stratification chart only 6.36 % of treated hypertensives had a Low Risk; while 35.65 % had a Medium Risk; 24.86 % High Risk and 33.14 % a Very High Risk. Despite of antihypertensive treatment most of our hypertensive patients (58%) continue to be at high CV risk indicating that to increase the reduction in their CV morbidity and mortality we need to improve our therapeutic approach by intensifying the control not only of BP levels but also the other CV risk factors.

Nitrendipine in the therapeutic management of elderly hypertensive patients : results of a multicenter trial

Two hundred forty-seven [142 women (57.49%)] elderly patients with essential hypertension (diastolic blood pressure between 95 and 114 mm Hg) and an average age of 67.4 +/- 6 years were included in an open multicenter ambulatory trial. One hundred thirty-seven had some kind of associated disease. After a 15-day washout period, the patients began nitrendipine therapy (10 mg o.d.). After 1 month, the dose was increased to 20 mg o.d. in patients with diastolic blood pressure (DPB) greater than or equal to 95 mm Hg, and thereafter 5 and 10 mg o.d. of bisoprolol was added to the maximal dose of nitrendipine (20 mg o.d.) in the case of patients with DBP greater than or equal to 95 mm Hg at the end of the second and third months, respectively. At the end of the 6-month follow-up period, the systolic and diastolic pressures had dropped -35 and -21 mm Hg, respectively, without any change in heart rate or Quetelet index. In 210 patients (84.9%), blood pressure control was achieved: 26 (10.5%) with 10 mg of nitrendipine, 149 (60.3%) with 20 mg of nitrendipine, and 35 (14.1%) by adding bisoprolol. The lipid profile, glucose, potassium, uric acid, or creatinine did not change negatively. Sixty-six (26.72%) patients reported clinical side effects, although these were mild; only 15 (6.07%) patients were excluded because of side effects. Nitrendipine has been shown to have a high therapeutic efficacy and biochemical tolerance for first-line treatment of elderly patients with mild-to-moderate essential hypertension with or without associated diseases.