Jaw-Wen Chen M.D.
Cardiology, Taipei Veterans General Hospital and Cardiovascular Research
Center, National Yang-Ming University

Hypertension is one of the top 10 leading causes of death in Taiwan.
According to the report in 2002, the incidence of hypertension is 21% in people aged above 15 years and up to 56% in people aged above 65 years in Taiwan.
However, more than half (54%) of the hypertensive patients did not take medication regularly in Taiwan.
Since the blood pressure itself is the most important determinant of the morbidity and mortality of patients with hypertension, the adequate control of hypertension is a critical issue both in epidemiology and in medical care.
Currently, various medications including diuretics, angiotensin converting enzyme inhibitors (ACEIs), β-adrenergic blockers, α-adrenergic blockers, calcium channel blockers (CCBs), and angiotensin receptor blockers (ARBs), the latest antihypertensive agent, are used for the first-line treatment for clinical hypertension. However, the development of side effects such as cough in ACEIs and postural hypotension in α-adrenergic blockers, may limit the clinical use of some medications in particular patients. On the other hand, medications with fewer side effects such as low-dose diuretics, long-acting CCBs and ARBs are suggested to use in elderly patients especially those with isolated systolic hypertension.
It has been shown that most of the antihypertensive drugs, except forα-adrenergic blockers, could improve the long-term morbidity and mortality in hypertensive patients. Previous evidence also suggest that some of them such as ACEIs and β-adrenergic blockers may have particular cardiovascular protection, in addition to their blood pressure lowering effects, in patients with cardiac hypertrophy, heart failure, diabetes mellitus, and/or renal insufficiency.
Recently, it is demonstrated that ARBs may also have some cardiovascular protective effects as that shown in LIFE and other large clinical studies. Then, in the most recent hypertension guidelines raised by European society of cardiology and hypertension in 2003, ARBs are suggested used as the first line antihypertensive drug not only for patients with ACEI-induced cough but also indicated for patients with diabetic nephropathy, proteinuria, or left ventricular hypertrophy. Furthermore, some of the ARBs have been also proven to have cardiac protection in patients with congestive heart failure. Accordingly, for patients with cardiac disease, anti-hypertensive medications particularly β-adrenergic blockers, ACEIs and ARBs should be implicated not only to blood pressure control but also to cardiac protection.
(2004-11-05)

|| BACK ||