Management of hypertension, Part II.

Abstract

Although calcium channel blockers and angiotensin-converting enzyme (ACE) inhibitors are effective in lowering blood pressure, no long-term data show their effect on morbidity and mortality in hypertensive patients. They are suggested as alternative initial therapy in hypertensive patients. Short-acting calcium channel blockers are to be used with caution or not at all in the treatment of hypertension. Nonhydropyridine calcium channel blockers may reduce the incidence of second infarction but not congestive heart failure or mortality in patients with ischemic heart disease. The ACE inhibitors increase insulin sensitivity and decrease intraglomerular pressure. In combination with a diuretic, they are the preferred agents in the treatment of diabetic patients with hypertension, especially those with nephropathy. In both hypertensive and normotensive patients, ACE inhibitors reduce morbidity and mortality resulting from congestive heart failure in patients with poor left ventricular function who are also being treated with a diuretic and/or digitalis. They do not, however, reduce strokes or myocardial infarctions in hypertensive patients.