Combination Antihypertensive Therapy: When to use it Diabetes
Combination Antihypertensive Therapy: When to use it Diabetes
George L. Bakris, MD, F.A.S.N., F.A.S.H. Professor of Medicine Director, ASH Comprehensive Hypertension Center The University of Chicago Medicine
Development of Antihypertensive Therapies
Effective but poorly tolerated
1940s 1950
As effective and better tolerated
As effective and even better tolerated
1957 1960s
1970s
1980s 1990s
? More effective for
SBP
2001- 2009
Direct vasodilators
ACE inhibitors
ARBs
Peripheral
Thiazides
-blockers
sympatholytics
Ganglion blockers
Veratrum alkaloids
diuretics Central 2 agonists
Calcium antagonists-
non DHPs
Calcium antagonists-
DHPs
-blockers
Direct Renin inhibitors
ETa Blockers
VPIs
Others
Evolution of Fixed Dose Combination Antihypertensive Therapies
1960s
1970s
1980s
1990s 2000- present
Combination
Diuretics
Aldactazide, Dyazide, Maxzide,
RAS Blockers with CCBs
SerApAs Guanabenz RAS Blockers
(Lotrel)
(reserpine,
with diuretics
hydralazine,
Beta blocker +diuretics
HCTZ)
CCBs+ ARBs
ARB + chlorthalidone
DRIs +ARBs
DRIs+ CCBs
TRIPLE Combos
(CCB+RAS Blocker + diuretic)
Rationale for Fixed-Dose Combination Therapy: Background
? Traditional antihypertensive therapy yields goal BP in ................
................
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