Candesartan seems to be the most efficient molecule, as far as potency goes. AT1 blockers Angiotensin II antagonist could be ideal candidates. To cap it we have the scenario where these newer drugs are yet to prove their merit in long term clinical trials.
To do or not to do is the real dilemma in anti-hypertensive drug therapy. We would like to call this as the step-up therapy.
However, when the drug companies promote the drugs is a simplified fashion, the gullible doctor falls a prey to the falsehoods and mysteries. Whatever article I write is put up on my website.
Now there are reports to show how this drug could produce foetal changes in the new born babies of mothers, who have been on labetolol during pregnancy.
As and when the pressure starts moving up, drugs could be reintroduced. Two important aspects of these drugs are their prolonged action, due to prolonged receptor blockage property with a peak trough ratio of more than 0.
A study in the UK showed that the highest incidence of vascular diseases was seen in the lowest socio-economic groups! We have been stressing, since the early seventies, about the need to step- down therapy, wherein the doctor starts cutting down the drugs and the dosage, once he achieves the desired blood pressure levels.
Here we are on a very wet wicket. All that could have changed their diagnosis, would be the tender loving care of the research team. Search for newer drugs at this point in time is not worthwhile.
I have written no such article. We have been in for quite a lot of disappointment in this field. This was being advocated for use in pregnancy hypertension at one time, and was freely being used, based on theoretical considerations.
It is estimated that in the USA, about million white-coat hypertensives are being treated with ACE inhibitors and Calcium channel blockers, at a phenomenal cost of 8.
Since this label encompasses many maladies, both known secondary hypertensionand the unknown, the office recording of blood pressure alone will not suffice to warrant treatment with drugs right away. There is more to it than meets the eye in this business of drug treatment of elevated blood pressure!
The most difficult diagnosis in medicine is the diagnosis of hypertension. This scenario is not rare as many would want to believe.
The latter is impossible at the present time. The gravity of the diagnostic dilemma must be clearer to the reader by now. I have been in this business for well over three decades.
So everyone should be cautious before circulating something along these lines. This should also be done in the following special circumstances. Labetolol is a good example. The question of therapy in medicine comes after the diagnosis.
We have enough and more drugs already. Roughly three times the annual budget of India. If one makes the correct diagnosis therapy becomes very simple.
We need more research into the aetio-pathogenesis of this enigma and that might give us better clues to the management. A recent meta-alaysis of the six major journals reporting anti-hypertensive treatment studies, revealed that all of them had flaws in the method of checking blood pressure.
Other drugs should be recommended for initial therapy only if they demonstrate their capacity to do just that, without serious side effects. We have been repeatedly stressing the importance of poverty as the basis of human ills. Past, Present, and Future. Elsewhere in this issue the details of drugless management of hypertension have been detailed.
There are more than six major guidelines in the world about the rules of the game of drug therapy of hypertension. Other drugs are also being tried. This can not be said about the latter drugs in the setting of uncomplicated hypertension.
Even after repeated checking of blood pressures over a period of three months, to make a diagnosis of mild-moderate hypertension, in the famous Australasian study, half the patients became normotensive on placebo alone,2 over a period of next three more months. Some of our patients may not respond to a larger doses if used initially, without trying the small dose first!
Ours was a plea to treat with empathy the human being with raised blood pressure, and not to target the blood pressure level, without any consideration for the human being that is labeled.The question of therapy in medicine comes after the diagnosis.
The most difficult diagnosis in medicine is the diagnosis of hypertension. Since this label encompasses many maladies, both known (secondary hypertension), and the unknown, the office recording of blood pressure alone will not suffice to warrant treatment with drugs right away.Download