A Basic Review on Hypertension, its Non-Pharmacological and Pharmacological Treatment
Abstract
Hypertension (HTN) Is Prevalent Leading Health Issue Around the World. It is significant cause for cardiovascular morbidity and mortality risk factors? The term "high blood pressure" refers to hypertension. It is long term condition in which the blood pressure in the arteries continuously increased. Distribution of HTN in developed nation, in obese, elderly, pregnancy and now a day’s teenager is also affected. The pathological mechanisms involved in HTN are genetics, sympathetic nervous system over activity, gender differences, cardiac output and peripheral vascular resistance, obstructive sleep apnoea, racial and ethnic factors, and many others. it can be prevented by reducing salt intake, weight loss, exercise, smoking cessation. There are many drugs are available for the treatment of this and its combination therapy is more effective. The pathophysiology, diagnosis, and current state of the disease's management are covered in this study.
Keywords: Hypertension, cardiovascular morbidity, cardiac output, peripheral vascular resistance
Keywords:
Hypertension, cardiovascular morbidity, cardiac output, peripheral vascular resistanceDOI
https://doi.org/10.22270/jddt.v14i3.6473References
Katori M, Majima M. A missing link between a high salt intake and blood pressure increase. Journal of Pharmacological Sciences. 2006;100 :370-90 https://doi.org/10.1254/jphs.CRJ06003X PMid:16651701
De Leeuw PW, Kroon AA. Salt and sensitivity. Hypertension. 2013;62(3):461-2. https://doi.org/10.1161/HYPERTENSIONAHA.113.01831 PMid:23897072
Granger JP, Alexander BT, Llinas M. Mechanisms of pressure natriuresis. Current Hypertension Reports. 2002;4:152-9 https://doi.org/10.1007/s11906-002-0040-3 PMid:11884271
Lifton RP, Gharavi AG, Geller DS. Molecular mechanisms of human hypertension. Cell. 2001; 104:545-1 https://doi.org/10.1016/S0092-8674(01)00241-0 PMid:11239411
Rodriguez-Iturbe B, Romero F, Johnson RJ. Pathophysiological mechanisms of salt-dependent hypertension. American Journal of Kidney Diseases. 2007;50 :655-72 https://doi.org/10.1053/j.ajkd.2007.05.025 PMid:17900467
Mullins LJ, Bailey MA, Mullins JJ. Hypertension, kidney, and transgenics: a fresh perspective. Physiological Reviews. 2006. https://doi.org/10.1152/physrev.00016.2005 PMid:16601272
Victor RG, Kaplan NM. Systemic hypertension: mechanisms and diagnosis. Braunwald's Heart Disease. 2008;8:1027
Johnson RJ, Herrera-Acosta J, et al. Subtle acquired renal injury as a mechanism of saltsensitive hypertension. New England Journal of Medicine. 2002;346 :913-23 https://doi.org/10.1056/NEJMra011078 PMid:11907292
Philips BG, Narkiewicz K, Pesek CA, et.al. Effects of obstructive sleep apnea on endothelin-1 and blood pressure. J Hypertens. 1999;17 :61-6 https://doi.org/10.1097/00004872-199917010-00010 PMid:10100095
Trinder J, Kleiman J, Carrington M, et al. Autonomic activity during human sleep as a function of time and sleep stage. J Sleep Res. 2001;10 :253-11 https://doi.org/10.1046/j.1365-2869.2001.00263.x PMid:11903855
Leuenberger U, Jacob E, Sweer L, et.al. Surges of muscle sympathetic nerve activity during obstructive apnea are linked to hypoxemia. J Appl Physiol. 1995;79 :581-7 https://doi.org/10.1152/jappl.1995.79.2.581 PMid:7592221
Okabe S, Hida W, Kikuchi Y, et al. Role of hypoxia on increased blood pressure in patients with obstructive sleep apnoea. Thorax. 1995;50 :28-6 https://doi.org/10.1136/thx.50.1.28 PMid:7886644 PMCid:PMC473701
Hickey KA, Rubanyi G, Paul RJ, Highsmith RF. Characterization of a coronary vasoconstrictor produced by cultured endothelial cells. See comment in PubMed Commons below Am J Physiol. 1985; 248: C550-556. https://doi.org/10.1152/ajpcell.1985.248.5.C550 PMid:3993773
Wagner OF, Christ G, Wojta J, Vierhapper H, Parzer S, et al. Polar secretion of endothelin-1 by cultured endothelial cells. See comment in PubMed Commons below J BiolChem. 1992; 267: 16066-16068. https://doi.org/10.1016/S0021-9258(18)41966-7
Beevers G, Lip GYH, O'Brie E. The pathophysiology of hypertension. BMJ 2001; 322:912-6. https://doi.org/10.1136/bmj.322.7291.912 PMid:11302910 PMCid:PMC1120075
Borrell LN, Menendez BS SP. Racial/ethnic disparities on self-reported hypertension in New York City: examining disparities among Hispanic subgroups. Ethn Dis.2011 Autumn;429-36
Brondolo E, Love EE, Pencille M, et.al. Racism and hypertension: a review of the empirical evidence and implications for clinical practice. American Journal of Hypertension. 2011; 24(5): 518-11. https://doi.org/10.1038/ajh.2011.9 PMid:21331054
Borghi C, Giuseppe CAF. Serum uric acid and cardio metabolic disease: another brick in the wall. Hypertension. 2017;69:1011-1013 https://doi.org/10.1161/HYPERTENSIONAHA.117.09081 PMid:28396532
Johnson RJ, Sanchez-Lozada LG, Mazzali M, et.al. What are the key arguments against uric acid as a true risk factor for hypertension. Hypertension. 2013;61: 948-3 https://doi.org/10.1161/HYPERTENSIONAHA.111.00650 PMid:23460277
YC Li, Kong J, Wei M, et al. 25-Dihydroxyvitamin D 3 is a negative endocrine regulator of the renin-angiotensin system. The Journal of Clinical Investigation. 2002;110:229-38 https://doi.org/10.1172/JCI0215219 PMid:12122115 PMCid:PMC151055
Forman JP. Vitamin D and hypertension current evidence and future directions anand vaidya, Hypertension. 2010;56;774-779 https://doi.org/10.1161/HYPERTENSIONAHA.109.140160 PMid:20937970
Hall JE Pathophysiology of obesity hypertension. Curr Hypertens Rep. 2000;2 :139-8 https://doi.org/10.1007/s11906-000-0073-4 PMid:10981140
Rahmouni K, Correia ML, Haynes WG, et.al. Obesity-associated hypertension: new insights into mechanisms. Hypertension 2005; 45; 9-5. https://doi.org/10.1161/01.HYP.0000151325.83008.b4 Mid:15583075
Wofford MR, Hall JE. Pathophysiology and treatment of obesity hypertension. Curr Pharm Des. 2004;10:3621 https://doi.org/10.2174/1381612043382855 PMid:15579059
Saxena TK, Maheshwari S, Saxena M. Aetiopathogenesis of type-2 diabetes mellitus: could chronic stress play an important role. J Assoc Physicians India. 2014; 62: 484-5
Saxena T, Ali AO, Saxena M. Pathophysiology of essential hypertension: an update, Expert Review of Cardiovascular Therapy. 2018; 34(3): 134-167.
Lastra G, Dhuper S, Johnson MS, et.al. Salt, aldosterone, and insulin resistance: impact on the cardiovascular system. Nat Rev Cardiol. 2010; 7: 577-7. https://doi.org/10.1038/nrcardio.2010.123 PMid:20697411
Zhou MS, Schulman IH, Raij L: Role of angiotensin II and oxidative stress in vascular insulin resistance linked to hypertension. Am J Physiol Heart Circ Physiol. 2009, 296: H833-H6 https://doi.org/10.1152/ajpheart.01096.2008 PMid:19151253
Schulman IH, Zhou MS. Vascular insulin resistance: a potential link between cardiovascular and metabolic diseases. Curr Hypertens Rep. 2009;11: 48-7. https://doi.org/10.1007/s11906-009-0010-0 PMid:19146801
Munzel T, Gori T, BabischW, et.al Cardiovascular effects of environmental noise exposure Eur Heart J 2014; 35: 829-839 https://doi.org/10.1093/eurheartj/ehu030 PMid:24616334 PMCid:PMC3971384
Zhang M, Mueller NT, Wang H, et. al. Hypertension maternal exposure to ambient particulate matter≤ 2.5 µm during pregnancy and the risk of high blood pressure in childhood. Hypertensionaha2018; 117: 1094. https://doi.org/10.1161/HYPERTENSIONAHA.117.10944 PMid:29760154 PMCid:PMC6002908
Smoking Talukder MH, Johnson WM, et al. Chronic cigarette smoking causes hypertension, increased oxidative stress, impaired NO bioavailability, endothelial dysfunction, and cardiac remodeling in mice. American Journal of Physiology-Heart and Circulatory Physiology. 2010;300:H388-96 https://doi.org/10.1152/ajpheart.00868.2010 PMid:21057039 PMCid:PMC3023256
Appel LJ, Miller ER, Seidler AJ, et al: Does supplementation of diet with "fish oil" reduce blood pressure? A meta-analysis of controlled clinical trials. Arch Intern Med 1993; 153:1429-1438. https://doi.org/10.1001/archinte.1993.00410120017003
Lionakis N, Mendrinos D, Sanidas E, Favatas G, Georgopoulou M. Hypertension in the elderly. World journal of cardiology. 2012;4(5):135. https://doi.org/10.4330/wjc.v4.i5.135 PMid:22655162 PMCid:PMC3364500
Kintiraki E, Papakatsika S, Kotronis G, Goulis DG, Kotsis V. Pregnancy-induced hypertension. Hormones. 2015;14(2):211-23. https://doi.org/10.14310/horm.2002.1582 PMid:26158653
Mittal BV, Singh AK. Hypertension in the developing world: challenges and opportunities. American Journal of Kidney Diseases. 2010;55(3):590-8. https://doi.org/10.1053/j.ajkd.2009.06.044 PMid:19962803
Jiang SZ, Lu W, Zong XF, Ruan HY, Liu Y. Obesity and hypertension. Experimental and Therapeutic Medicine. 2016;12(4):2395-9. https://doi.org/10.3892/etm.2016.3667 PMid:27703502 PMCid:PMC5038894
Drukteinis JS, Roman MJ, Fabsitz RR, Lee ET, Best LG, Russell M, Devereux RB. Cardiac and systemic hemodynamic characteristics of hypertension and prehypertension in adolescents and young adults: the Strong Heart Study. Circulation. 2007;115(2):221-7. https://doi.org/10.1161/CIRCULATIONAHA.106.668921 PMid:17210838
McNiece KL, Gupta-Malhotra M, Samuels J, Bell C, Garcia K, Poffenbarger T, Sorof JM, Portman RJ. Left ventricular hypertrophy in hypertensive adolescents: analysis of risk by 2004 National High Blood Pressure Education Program Working Group staging criteria. Hypertension. 2007;50(2):392-5. https://doi.org/10.1161/HYPERTENSIONAHA.107.092197 PMid:17592068 PMCid:PMC3582191
Tołwińska J, Głowińska B, Urban M, Pieciukiewicz B. Ultrasonographic evaluation of atherosclerotic changes in carotid and brachial arteries in obese and hypertensive children. Przeglad Lekarski. 2005;62(12):1346-51.
Sorof JM, Alexandrov AV, Garami Z, Turner JL, Grafe RE, Lai D, Portman RJ. Carotid ultrasonography for detection of vascular abnormalities in hypertensive children. Pediatric Nephrology. 2003;18:1020-4. https://doi.org/10.1007/s00467-003-1187-0 PMid:12883975
Sorof JM, Cardwell G, Franco K, Portman RJ. Ambulatory blood pressure and left ventricular mass index in hypertensive children. Hypertension. 2002;39(4):903-8. https://doi.org/10.1161/01.HYP.0000013266.40320.3B PMid:11967247
Tracy RE, Newman III WP, Wattigney WA, Srinivasan SR, Strong JP, Berenson GS. Histologic features of atherosclerosis and hypertension from autopsies of young individuals in a defined geographic population: the Bogalusa Heart Study. Atherosclerosis. 1995;116(2):163-79. https://doi.org/10.1016/0021-9150(95)05525-2 PMid:7575772
Chamontin B, Amar J, Barthe P, Salvador M. Blood pressure measurements and left ventricular mass in young adults with arterial hypertension screened at high school check-up. Journal of Human Hypertension. 1994;8(5):357-61.
Lurbe E, Álvarez J, Redon J. Diagnosis and treatment of hypertension in children. Current Hypertension Reports. 2010;12:480-6. https://doi.org/10.1007/s11906-010-0155-x PMid:20872099
Carretero OA, Oparil S. Essential hypertension: part I: definition and etiology. Circulation. 2000;101(3):329-35. https://doi.org/10.1161/01.CIR.101.3.329 PMid:10645931
Perloff D, Grim C, Flack J, Frohlich ED, Hill M, McDonald M, Morgenstern BZ. Human blood pressure determination by sphygmomanometry. Circulation. 1993;88(5):2460-70. https://doi.org/10.1161/01.CIR.88.5.2460 PMid:8222141
Prisant LM, Alpert BS, Robbins CB, Berson AS, Hayes M, Cohen ML, Sheps SG. American national standard for nonautomated sphygmomanometers summary report. American Journal of Hypertension. 1995;8(2):210-3. https://doi.org/10.1016/0895-7061(94)00175-B PMid:7755953
Black HR, Weltin G, JAFFE C. The limited echocardiogram: a modification of standard echocardiography for use in the routine evaluation of patients with systemic hypertension. The American Journal of Cardiology. 1991; 67(11):1027-30. https://doi.org/10.1016/0002-9149(91)90178-N PMid:2018006
Macmohan S, Cutler J, Brittain E, Higgins M. Obesity and hypertension: epidemiological and clinical issues. European Heart Journal. 1987;8(suppl_B):57-70. https://doi.org/10.1093/eurheartj/8.suppl_B.57 PMid:3301356
Schotte DE, Stunkard AJ. The effects of weight reduction on blood pressure in 301 obese patients. Archives of Internal Medicine. 1990;150(8):1701-4. https://doi.org/10.1001/archinte.1990.00040031701019
Whelton PK, Kumanyika SK, Cook NR, Cutler JA, Borhani NO, Hennekens CH, Kuller LH, Langford H, Jones DW, Satterfield S, Lasser NL. Efficacy of nonpharmacologic interventions in adults with high-normal blood pressure: results from phase 1 of the Trials of Hypertension Prevention. Trials of Hypertension Prevention Collaborative Research Group. The American Journal of Clinical Nutrition. 1997;65(2):S652-9. https://doi.org/10.1093/ajcn/65.2.652S PMid:9022561
He J, Whelton PK, Klag MJ. Dietary fiber supplementation and blood pressure reduction: a meta-analysis of controlled clinical trials. Am J Hypertens. 1996;9:L21. https://doi.org/10.1016/0895-7061(96)81697-9
Elliott P, Stamler J, Nichols R, Dyer AR, Stamler R, Kesteloot H, Marmot M. Intersalt revisited: further analyses of 24 hour sodium excretion and blood pressure within and across populations. BMJ. 1996;312(7041):1249-53. https://doi.org/10.1136/bmj.312.7041.1249 PMid:8634612 PMCid:PMC2351086
Whelton PK, He J, Cutler JA, Brancati FL, Appel LJ, Follmann D, Klag MJ. Effects of oral potassium on blood pressure: meta-analysis of randomized controlled clinical trials. JAMA. 1997;277(20):1624-32. https://doi.org/10.1001/jama.1997.03540440058033 PMid:9168293
Markovitz JH, Matthews KA, Kannel WB, Cobb JL, D'Agostino RB. Psychological predictors of hypertension in the Framingham study: is there tension in hypertension. JAMA. 1993;270(20):2439-43. https://doi.org/10.1001/jama.1993.03510200045030 PMid:8230620
Jee SH, He J, Appel LJ, Whelton PK, Suh II, Klag MJ. Coffee consumption and serum lipids: a meta-analysis of randomized controlled clinical trials. American Journal of Epidemiology. 2001; 153(4):353-62. https://doi.org/10.1093/aje/153.4.353 PMid:11207153
Witteman JC, Willett WC, Stampfer MJ, Colditz GA, Sacks FM, Speizer FE, Rosner B, Hennekens CH. A prospective study of nutritional factors and hypertension among US women. Circulation. 1989; 80(5):1320-7. https://doi.org/10.1161/01.CIR.80.5.1320 PMid:2805268
Ascherio A, Rimm EB, Giovannucci EL, Colditz GA, Rosner B, Willett WC, Sacks F, Stampfer MJ. A prospective study of nutritional factors and hypertension among US men. Circulation. 1992;86(5):1475-84. https://doi.org/10.1161/01.CIR.86.5.1475 PMid:1330360
Mizushima S. Dietary magnesium intake and blood pressure: A review of the observational studies. J. Hypertens 1996;14(1):S239.
Arroll B, Beaglehole R. Does physical activity lower blood pressure: a critical review of the clinical trials. Journal of Clinical Epidemiology. 1992;45(5):439-47. https://doi.org/10.1016/0895-4356(92)90093-3 PMid:1588350
Ketelhut RG, Franz IW, Scholze JÜ. Regular exercise as an effective approach in antihypertensive therapy. Medicine & Science in Sports & Exercise. 2004;36(1):4-8. https://doi.org/10.1249/01.MSS.0000106173.81966.90 PMid:14707760
Worthley SG, Tsioufis CP, Worthley MI, Sinhal A, Chew DP, Meredith IT, Malaiapan Y, Papademetriou V. Safety and efficacy of a multi-electrode renal sympathetic denervation system in resistant hypertension: the EnligHTN I trial. European Heart Journal. 2013; 34(28):2132-40. https://doi.org/10.1093/eurheartj/eht197 PMid:23782649 PMCid:PMC3717311
Symplicity HTN-1 Investigators. Catheter-based renal sympathetic denervation for resistant hypertension: durability of blood pressure reduction out to 24 months. Hypertension. 2011; 57(5):911-7. https://doi.org/10.1161/HYPERTENSIONAHA.110.163014 PMid:21403086
Antihypertensive T, Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin vs usual care: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT). JAMA 2002;288(23):2998-3007. https://doi.org/10.1001/jama.288.23.2998 PMid:12479764
Hollenberg NK. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic. Current Hypertension Reports. 2003;5(3):183-5. https://doi.org/10.1177/14746514030030040501
Dahlöf B, Devereux R, Faire UD, Fyhrquist F, Hedner T, Ibsen H, Julius S, Kjeldsen S, Kristianson K, Lederballe-Pedersen O, Lindholm LH. The Losartan Intervention For Endpoint reduction (LIFE) in hypertension study: rationale, design, and methods. American Journal of Hypertension. 1997;10(7):705-13.
Sanoski CA. Aliskiren: an oral direct renin inhibitor for the treatment of hypertension. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2009;29(2):193-212. https://doi.org/10.1592/phco.29.2.193 PMid:19170589
Costanzo P, Perrone-Filardi P, Petretta M, Marciano C, Vassallo E, Gargiulo P, Paolillo S, Petretta A, Chiariello M. Calcium channel blockers and cardiovascular outcomes: a meta-analysis of 175 634 patients. Journal of Hypertension. 2009;27(6):1136-51. https://doi.org/10.1097/HJH.0b013e3283281254 PMid:19451836
Psaty BM, Lumley T, Furberg CD, Schellenbaum G, Pahor M, Alderman MH, Weiss NS. Health outcomes associated with various antihypertensive therapies used as first-line agents: a network meta-analysis. JAMA 2003;289(19):2534-44. https://doi.org/10.1001/jama.289.19.2534 Mid:12759325
Wing LM, Reid CM, Ryan P, Beilin LJ, Brown MA, Jennings GL, Johnston CI, McNeil JJ, Macdonald GJ, Marley JE, Morgan TO. A comparison of outcomes with angiotensin-converting-enzyme inhibitors and diuretics for hypertension in the elderly. New England Journal of Medicine. 2003;348(7):583-92. https://doi.org/10.1056/NEJMoa021716 PMid:12584366
Pitt B, Remme W, Zannad F, Neaton J, Martinez F, Roniker B, Bittman R, Hurley S, Kleiman J, Gatlin M. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. New England Journal of Medicine. 2003;348(14):1309-21. https://doi.org/10.1056/NEJMoa030207 PMid:12668699
Pitt B, Zannad F, Remme WJ, Cody R, Castaigne A, Perez A, Palensky J, Wittes J. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. New England Journal of Medicine. 1999;341(10):709-17. https://doi.org/10.1056/NEJM199909023411001 PMid:10471456
Ezekowitz JA, McAlister FA. Aldosterone blockade and left ventricular dysfunction: a systematic review of randomized clinical trials. European Heart Journal. 2009;30(4):469-77. https://doi.org/10.1093/eurheartj/ehn543 PMid:19066207
Worthley MI, Corti R, Worthley SG. Vasopeptidase inhibitors: will they have a role in clinical practice. British Journal of Clinical Pharmacology. 2004;57(1):27-36. https://doi.org/10.1046/j.1365-2125.2003.01947.x PMid:14678337 PMCid:PMC1884420
Daugherty SL, Powers JD, Magid DJ, Tavel HM, Masoudi FA, Margolis KL, O'Connor PJ, Selby JV, Ho PM. Incidence and prognosis of resistant hypertension in hypertensive patients. Circulation. 2012;125(13):1635-42. https://doi.org/10.1161/CIRCULATIONAHA.111.068064 PMid:22379110 PMCid:PMC3343635
Chrysant SG, Fagan T, Glazer R, Kriegman A. Effects of benazepril and hydrochlorothiazide, given alone and in low-and high-dose combinations, on blood pressure in patients with hypertension. Archives of Family Medicine. 1996;5(1):17-24. https://doi.org/10.1001/archfami.5.1.17 PMid:8542050
Chrysant SG. Antihypertensive effectiveness of low-dose lisinopril-hydrochlorothiazide combination: a large multicenter study. Archives of Internal Medicine. 1994;154(7):737-43. https://doi.org/10.1001/archinte.1994.00420070047005 PMid:8147677
Gradman AH, Kad R. Renin inhibition in hypertension. Journal of the American College of Cardiology. 2008;51(5):519-28. https://doi.org/10.1016/j.jacc.2007.10.027 PMid:18237679
MacKay JH, Arcuri KE, Goldberg AI, Snapinn SM, Sweet CS. Losartan and low-dose hydrochlorothiazide in patients with essential hypertension: a double-blind, placebo-controlled trial of concomitant administration compared with individual components. Archives of Internal Medicine. 1996;156(3):278-85. https://doi.org/10.1001/archinte.1996.00440030072009 Mid:8572837
Frishman WH, Ram CV, McMahon FG, Chrysant SG, Graff A, Kupiec JW, Hsu H. Comparison of amlodipine and benazepril monotherapy to amlodipine plus benazepril in patients with systemic hypertension: a randomized, double‐blind, placebo‐controlled, Parallel‐Group study. The Journal of Clinical Pharmacology. 1995;35(11):1060-6. https://doi.org/10.1002/j.1552-4604.1995.tb04027.x PMid:8626878
Philipp T, Smith TR, Glazer R, Wernsing M, Yen J, Jin J, Schneider H, Pospiech R. Two multicenter, 8-week, randomized, double-blind, placebo-controlled, parallel-group studies evaluating the efficacy and tolerability of amlodipine and valsartan in combination and as monotherapy in adult patients with mild to moderate essential hypertension. Clinical therapeutics. 2007;29(4):563-80. https://doi.org/10.1016/j.clinthera.2007.03.018 PMid:17617280
Chrysant SG, Melino M, Karki S, Lee J, Heyrman R. The combination of olmesartan medoxomil and amlodipine besylate in controlling high blood pressure: COACH, a randomized, double-blind, placebo-controlled, 8-week factorial efficacy and safety study. Clinical Therapeutics. 2008;30(4):587-604. https://doi.org/10.1016/j.clinthera.2008.04.002 PMid:18498909
Oparil S, Yarows SA, Patel S, Fang H, Zhang J, Satlin A. Efficacy and safety of combined use of aliskiren and valsartan in patients with hypertension: a randomised, double-blind trial. The Lancet. 2007;370(9583):221-9. https://doi.org/10.1016/S0140-6736(07)61124-6 PMid:17658393
Salvetti A, Magagna A, Innocenti P, Ponzanelli F, Cagianelli A, Cipriani M, Gandolfi E, Del Prato C, Ballestra AM, Saba P, Giuntoli F. The combination of chlorthalidone with nifedipine does not exert an additive antihypertensive effect in essential hypertensives: a crossover multicenter study. Journal of Cardiovascular Pharmacology. 1991;17(2):332-5. https://doi.org/10.1097/00005344-199102000-00021 PMid:1709240
Weir MR, Weber MA, Punzi HA, Serfer HM, Rosenblatt S, Cady WJ. A dose escalation trial comparing the combination of diltiazem SR and hydrochlorothiazide with the monotherapies in patients with essential hypertension. Journal of Human Hypertension. 1992;6(2):133-8.
Siscovick DS, Raghunathan TE, Psaty BM, Koepsell TD, Wicklund KG, Lin X, Cobb L, Rautaharju PM, Copass MK, Wagner EH. Diuretic therapy for hypertension and the risk of primary cardiac arrest. New England Journal of Medicine. 1994;330(26):1852-7. https://doi.org/10.1056/NEJM199406303302603 PMid:8196728
Carlberg B, Samuelsson O, Lindholm LH. Atenolol in hypertension: is it a wise choice. The Lancet. 2004;364(9446):1684-9. https://doi.org/10.1016/S0140-6736(04)17355-8 PMid:15530629
Lindholm LH, Carlberg B, Samuelsson O. Should β blockers remain first choice in the treatment of primary hypertension? A meta-analysis. The Lancet. 2005;366(9496):1545-53. https://doi.org/10.1016/S0140-6736(05)67573-3 PMid:16257341
Bradley HA, Wiysonge CS, Volmink JA, Mayosi BM, Opie LH. How strong is the evidence for use of beta-blockers as first-line therapy for hypertension? Systematic review and meta-analysis. Journal of Hypertension. 2006;24(11):2131-41. https://doi.org/10.1097/01.hjh.0000249685.58370.28 PMid:17053529
Wing LM, Chalmers JP, West MJ, Russell AE, Morris MJ, Bune CA, Southgate DO. Enalapril and atenolol in essential hypertension: attenuation of hypotensive effects in combination. Clinical and Experimental Hypertension. Part A: Theory and Practice. 1988;10(1):119-33. https://doi.org/10.3109/10641968809046803 PMid:2832102
Dahlöf B, Innocenti AD, Elmfeldt D, Puig JG, Gundersen T, Hosie J, Januszewicz W, Lindström CJ, Magometschnigg D, Tanser P, Toutouzas P. Felodipine-Metoprolol Combination Tablet: Maintained Health-Related Quality of Life in the Presence of Substantial Blood Pressure Reduction. American Journal of Hypertension. 2005;18(10):1313-9. https://doi.org/10.1016/j.amjhyper.2005.04.017 PMid:16202854
Frishman WH, Hainer JW, Sugg J. A factorial study of combination hypertension treatment with metoprolol succinate extended release and felodipine extended release: results of the Metoprolol Succinate-Felodipine Antihypertension Combination Trial (M-FACT). American Journal of Hypertension. 2006;19(4):388-95. https://doi.org/10.1016/j.amjhyper.2005.10.007 PMid:16580575
Mehta JL, Lopez LM. Rebound hypertension following abrupt cessation of clonidine and metoprolol: Treatment with labetalol. Archives of Internal Medicine. 1987;147(2):389-90. https://doi.org/10.1001/archinte.1987.00370020207067
Published



How to Cite
Issue
Section
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).