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Figure 1. Algorithm for the treatment of hypertension from the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. BP indicates blood pressure; HTN, hypertension; SBP, systolic blood pressure; DBP, diastolic blood pressure; ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin II receptor blocker; BB, beta blocker; CCB, calcium channel blocker. Adapted from JNC-7.3
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Figure 2. Combination therapy (number of medications) needed to achieve target systolic blood pressure (SBP) goals. UKPDS indicates United Kingdom Prospective Diabetes Study; RENAAL, Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan; ALLHAT, Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial; IDNT, Irbesartan in Diabetic Nephropathy Trial; HOT, Hypertension Optimal Treatment; INVEST, International Verapamil-Trandolapril Study; ABCD, Appropriate Blood Pressure Control in Diabetes; MDRD, Modification of Diet in Renal Disease; AASK, American Study of Kidney Disease and Hypertension. Adapted from Bakris et al.6
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Figure 3. Response of blood pressure to treatment with lisinopril and hydrochlorothiazide (HCTZ). Adapted from Chrysant, 1994.41
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Figure 4. Systolic blood pressure (SBP) goal attainment in subpopulations of the Irbesartan/Hydrochlorothiazide Blood Pressure Reductions in Diverse Patient Populations (INCLUSIVE) study.33,49-52 HCTZ indicates hydrochlorothiazide; BP, blood pressure.
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Figure 5. Response of blood pressure to treatment with bisoprolol and hydrochlorothiazide (HCTZ). Adapted from Frishman et al, 1994.19
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Figure 6. Cardiovascular outcomes in the Anglo-Scandinavian Cardiac Outcomes Trial - Blood Pressure Lowering Arm (ASCOT-BPLA) study.25,61 MI indicates myocardial infarction; CHD, coronary heart disease; CV, cardiovascular; HF, heart failure.
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Single Drug Classes
|
Combination Drugs
|
Diuretics
Thiazide
(and Thiazide like)
Loop
Potassium-sparing
Selective aldosterone
antagonists |
Diuretic + diuretic
Adrenergic inhibitor +
vasodilator
Beta-blocker
Central alpha-agonist
Alpha-blocker
ACEI
ARB
|
Adrenergic inhibitors
Peripheral sympathetic
inhibitors
Central alpha-agonists
Alpha-blockers
Beta-blockers
Alpha-beta blocke |
ACEI + CCB
|
Direct vasodilators
Hydralazine
Minoxidil
Nitrates
|
ACEI + ARB |
CCBs
Dihydropyridine
Non-dihydropyridine
|
Dihydropyridine CCB +
non-dihydropyridine
CCB |
ACEIs
ARBs |
|
| Vasopeptidase inhibitors |
|
| Endothelin antagonists |
|
ACEI indicates angiotensin-converting enzyme inhibitor; ARB, angiotensin II receptor blocker; CCB, calcium channel blocker.
|
|
Table 1. Single and combination drugs for the chronic treatment of HTN.3,22
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