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Document Details :
Title: De huidige aanpak van hypertensie
Author(s): FAGARD RH
Journal: Tijdschrift voor Geneeskunde
Volume: 58 Issue: 18 Date: 2002
In deze bijdrage worden de nieuwste richtlijnen voor de aanpak van hypertensie overlopen, alsook de gerandomiseerde gecontroleerde studies waarbij nieuwere en oudere antihypertensiva werden vergeleken op het gebied van morbiditeit en mortaliteit.
The Guidelines Subcommittee of the World Health Organization and the International Society of Hypertension published their most recent guidelines in 1999. The core of the document deals with the classification of hypertension by blood pressure level, the risk stratification to quantify prognosis in the individual patient, as well as with guidelines for management and pharmacological treatment, with emphasis on the overall risk of the patient rather than on blood pressure alone. Risk stratification is based on classical risk factors, target organ damage and associated cardiovascular and renal diseases.
Whereas older outcome trials compared the influence mainly of diuretics and beta-blockers with placebo or no treatment on the incidence of cardiovascular morbidity and mortality, more recent trials randomised patients to newer or older drugs. A comprehensive meta-analysis of such trials published up to the year 2000, revealed that the effects of antihypertensive treatment on fatal and nonfatal cardiovascular events combined were similar for angiotensin converting enzyme inhibitors, calcium channel blockers and older drugs, though some differences were observed for cause-specific endpoints.