Clinical trials for hypertension: expectations fulfilled and unfulfilled.
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Biomedical subjects
Publications and source records attributed to Norman M Kaplan.
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Hypertension remains the most common risk factor for cardiovascular morbidity and mortality. Its incidence is rising in both ageing and obese populations, but its control remains inadequate worldwide. We address several persisting controversies that may interfere with appropriate management of hypertension. They include: the reasons behind the increasing incidence of hypertension and the possible ways to slow the process, especially by lifestyle changes; the need for overall cardiovascular risk assessment; the major issues in the decision to institute drug therapy and the choice of drugs; and the importance of screening for various identifiable causes. We provide the background for these controversies, followed by some opinions on how to guide practitioners to offer more effective management of hypertension.
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Hypertension is growing in prevalence and most of this growth represents isolated systolic hypertension in the elderly. Attempts at prevention are critical but likely are ineffectual. Therefore, the delivery and acceptance of current medical regimens must be improved.
Hypertension that remains above 140/90 mmHg despite the use of three antihypertensive drugs in a rational combination at full doses and including a diuretic is known as 'resistant'. The percentage of hypertensives whose condition is resistant varies in large part upon the setting: those seen in general practice show a prevalence of perhaps 5%; those seen by nephrologists, probably 50%. This paper reviews the major causes of resistant hypertension and provides specific recommendations for the evaluation and management of patients with this threatening condition.
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