Via practica 3/2009

Current combination of beta-blockers and diuretics in treatment of hypertension

Author of the article shows impact of meta-analysis and recent randomized trials concluded on population with hypertension, which push national authorities re-write its recommendations and guidelines for management and treatment of hypertension, in regards to using of beta-blocker agents or its combinations with diuretics in this indication. There is not any evidence of benefits of using betablockers in monotherapy or combination therapy beta-blocker plus diuretic compare to other antihypertensial regimens. Using of beta-blockers in such indication looks like suboptimal and using of atenolol in present time even obsolete – as a result of increase of all cause mortality stroke and MI (myocardial infarction) rate. Betablocade in treatment of non complicated hypertension has position of symptomatic approach, unless concomitant particular kind of coronary heart disease are present – after MI, permanent atrial fibrillation and chronic heart failure, where the evidence of benefit are strong. In the article author also mentions an importance of considering of central arterial blood pressure compare to brachial one, for estimating of total cardiovascular risk of hypertensive individual. Also brings short review of the methods, which indirectly measure arterial stiffness, which directly affects central arterial pressure. In near future, pulse wave velocity (PWV) and augmentation index (Aix) measurements will play an important role in cardiovascular risk stratification and effectiveness of antihypertensial treatment as well.

Keywords: arterial hypertension, cardiovascular risk, central arterial pressure, vessel wall stiffness, beta-blockers, diuretics, combination therapy, paradigm shifts