Pharmacologic Treatment of Hypertension


Hypertension, an elevation of systemic arterial blood pressure (BP), is a very common chronic disease in the United States. The overall prevalence of hypertension among U.S. adults is 29.0%, and it increases to 64.9% in adults aged 60 years or older (1). Hypertension was associated with a total of $46 billion in health care services, medications, and missed days of work in the United States in 2011 (2). Appropriate management of hypertension reduces the risk for cardiovascular disease, renal disease, cerebrovascular disease, and death (3–6). However, deter- mining the most appropriate BP targets, particularly for adults aged 60 years or older, has been controversial. Debate about the goal for systolic BP (SBP) among adults treated for hypertension has intensified, especially in light of recent recommendations (7). In addition, when selecting BP targets for adults aged 60 years or older, clinicians need to consider comorbid conditions that could affect treatment choice. Treatments for hypertension include lifestyle modifications, such as weight loss, dietary modification, and increased physical activity, and antihypertensive medications, which commonly include thiazide-type diuretics, angiotensin- converting enzyme inhibitors (ACEIs), angiotensin-receptor blockers (ARBs), calcium-channel blockers.

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