Hypertension and Sexual Dysfunction

Hypertension is a major independent cardiovascular risk factor; and also a marker of survival risk. Quality of life during the treatment of hypertension is an important health issue; as one in every five treated patients with hypertension will discontinue their therapy due to sideeffects.1 Discontinuation of therapy; and poor compliance with therapy; will eventually lead to a poorer outcome. The appearance of treatment-related side- effects may actually make patients feel worse than they did prior to treatment; when most hypertensive patients are asymptomatic. Sexual dysfunction is a potential side-effect of therapy; and may lead to poor therapy compliance

Angiotensin II Type 1 Receptor Antagonists and their Combinations in the Treatment of Hypertension

The pathophysiology of hypertension is not multifactorial in nature; and there is a complex interplay of mechanisms of control and counter-regulatory responses activated by drugs. The problem for clinicians is that it is not really possible to recognise the various clinical phenotypes of hypertension. In other words; the heterogeneity of hypertension remains a clinical problem.1 Current overwhelming evidence is that the most important treatment concept in the management of hypertension is that treatment should reduce blood pressure to goal levels.2 The majority of hypertensive patients will need two or more antihypertensive drugs to control their blood pressure at goal. Conceptually; a strong case can be made for the early use of combination therapy in the treatment of hypertension.3

Beta Blockers and their Combinations in the Management of Hypertension

Beta blockers have been prescribed for the treatment of primary hypertension for a very long time. Currently; it is doubtful whether this is still a good idea. In fact; many are of the opinion that beta blockers should be relegated to a fourth-line drug; if used at all; for the treatment of hypertension. So what happened? Why the change of heart? Basically; two issues are driving this new view of beta blockers.Firstly; beta blockers are cardioprotective when given to patients with a recent myocardial infarction and reduce subsequent mortality significantly. Certain types of beta blockers reduce mortality in patients with heart failure. This efficacy in secondary protection was translated to primary prevention without a critical assessment; and this is particularly the case in hypertension.Secondly; reducing blood pressure by any means may not automatically translate into reduced cardiovascular morbidity and mortality. This happened with beta blockers in the primary treatment of hypertension

Antihypertensive Treatment in the Elderly

Hypertension is a major risk factor for cardiovascular disease; but it is also very prevalent in the community. These two factors combined prompted the World Health Organization (WHO) to report that high blood pressure is the first cause of death worldwide.1 The prevalence of hypertension has been estimated to be approximately one in four; and this increases with age to such an extent that almost two-thirds of people over the age of 60 years have hypertension.2

Antihypertensive Treatment in the Elderly

Hypertension is a major risk factor for cardiovascular disease; but it is also very prevalent in the community. These two factors combined prompted the World Health Organization (WHO) to report that high blood pressure is the first cause of death worldwide.1 The prevalence of hypertension has been estimated to be approximately one in four; and this increases with age to such an extent that almost two-thirds of people over the age of 60 years have hypertension.2

Management Issues in Hypertensive Diabetics

Diabetes mellitus and hypertension are common clinical conditions that often co-exist. This combination has been called the deadly duet to emphasise the increased cardiovascular risk when the two conditions co-exist. Hypertension occurs more commonly in diabetics than in comparable non-diabetics; as the prevalence of hypertension in diabetics is about two times higher than that of hypertension as observed in the general population. In type 2 diabetes mellitus; hypertension is often present as part of a possible common underlying metabolic abnormality; such as insulin resistance. However; in type 1 diabetes mellitus; hypertension is often due to the onset of diabetic nephropathy

Hypertensive Crisis

Hypertension is a common medical problem. It affects approximately one in four adults worldwide; with evidence that the prevalence is rising. In the USA; approximately 30 of adults have some form of hypertension.1 It is estimated that 1-2 of the hypertensive population will present with an acute and severe elevation of blood pressure at some stage; i.e. hypertensive crisis: systolic blood pressure 180 mmHg; or diastolic blood pressure 120 mmHg.2

Hypertension

Approximately one in four adults has hypertension; a prevalence that increases with age and may reach to two out of three adults older than 70 years of age. In the Framingham Heart Study 65-75 of hypertension in the elderly is of the isolated systolic hypertension variety. Hypertension causes a two- to threefold increased risk of atherosclerotic cardiovascular events. Hypertension clusters with dyslipidaemia; insulin resistance; glucose intolerance and obesity in more than 80 of cases.1 The great majority of hypertensives thus have additional cardiovascular risk factors. The global cardiovascular risk; of which hypertension is but one component; is best appreciated by the use of risk charts such as the Framingham Risk Score