Hypertension

• Patient assessment- brief overview

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• Guidelines
• New Zealand Guidelines: Threshold for Pharmacologic Treatment
• New Zealand Guidelines: Emerging Risk Factors
• Selected Information From JNC 7

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• Left Ventricular Hypertrophy
• LVH on ECG and prognosis
• LVH with echo and prognosis
• Africans have more LVH
• LVH- more information

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• Hypertension Trials
• Beta-blockers no longer first or second line agents for treatment of hypertension for all patients.
• Review of Hypertension trials- 2005
• ASCOT, LIFE, ALLHAT, ANBP2

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• Ambulatory and Home BP Monitoring
• Introduction

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• Lifestyle Measures
• Impact on Hypertension

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• Resistant Hypertension
• Meet the experts session- ESC 2008

Hypertension Trials- ASCOT

The final results of this trial were published in the Lancet (Sept 4, 2005).

There was a small difference in blood pressure levels in the trial in favour of the amlodipine/perindopril group. The editorialists maintained that this difference may have been sufficient to explain the findings of the trial.

Others, reported on the web, would tend to believe that beta-blockers should no longer be first line agents particularly in the elderly without ischaemic heart disease. The increased risk of diabetes in groups treated with atenolol was confirmed in the final report of the study.

To routinely avoid relatively cheap medication (beta-blockers) to control a common condition would have major cost implications. However, we know that most patients will require multiple drug therapy to control hypertension well, and we should endeavour to introduce other agents such as ace-inhibitors early.