Full Description
There is clear evidence that in severe hypertension lowering blood pressure, by drug therapy decreases the incidence of major cardiovascular events. Recent studies suggest that such benefit may also extend to patients with mild to moderate hypertension. The putative benefits of drugs may be offset, however, by their adverse effects and a prime example is the increased incidence of impotence and metabolic disorders in patients on thiazide diuretics. There is, therefore, a real need to look further into the therapy of patients with mild to moderate hypertension. The ideal drug in such patients would oppose the basic mechanisms responsible for the elevation in blood pressure, would prevent counter-regulatory responses and would have minimal side-effects in both the short-term and the long-term, the latter being of particular importance to younger patients. These aspects were considered at the symposium "Mild hypertension. Current con troversies and new approaches" held at Titisee in West Germany, October 13-15 in 1983. The foundation for discussion was set with an exposition of the neural and hormonal regulation of blood pressure in normal man followed by a consideration of the pos‾ible pathophysiological mechanisms involved in patients with hypertension. Particular at tention was focused on the central nervous system and on effects governed by activity of the peripheral nervous system as these may well provide further opportunities for logical therapeutic intervention in clinical hypertension. The current management of mild to moderate hypertension was then reviewed.
Contents
Introduction: Some neurological aspects of blood pressure control.- Central and peripheral control of blood pressure.- Central nervous system control of blood pressure.- Blood pressure control and the peripheral sympathetic nervous system.- Baroreflex function and centrally acting antihypertensive drugs.- Haemodynamic effects of antihypertensive agents in man.- Vascular autonomy and its relation to the action of antihypertensive drugs.- General discussion.- Therapeutic consequences.- Therapeutic decisions in mild hypertension: an introductory overview.- When to treat? Recent trials in mild hypertension. Epidemiological data and conclusions.- Current assessment of the stepped-care treatment of mild hypertension: diuretics, beta-blockers, vasodilators versus clonidine.- Use of centrally-acting agonists in the treatment of mild hypertension in the elderly patient.- Sympathetic nervous system activity in the obese hypertensive patient: potential role for central alpha-adrenoreceptor agonists.- Clonidine for treating patients with mild hypertension and angina pectoris.- New pharmacological approaches in the treatment of mild hypertension. The potential role of converting enzyme inhibitors and calcium blocking agents.- General discussion.- Advances in treatment.- Rate-controlled drug delivery and the reduction of risk.- Clonidine rate — controlled system: technology and kinetics.- Absorption of clonidine from a transdermal therapeutic system when applied to different body sites.- Clinical experience with clonidine TTS.- Clinical effectiveness of the transdermal route of antihypertensive treatment.- Roundtable discussion on the use of transdermal medication: clinical characteristics and skin reactions.- Panel discussion: the role of clonidine in the treatment of mildhypertension.- Concluding remarks.- Participants.
