Treatment of arterial hypertension

Arterial hypertension is the most common internal disease. Treatment is highly effective in lowering cardiovascular morbidity and mortality and is indicated based on total cardiovascular risk as assessed by all relevant risk factors. Target blood pressure is <140/90 mmHg, or with concomitant diabetes mellitus or renal insufficiency <130/80 mmHg. Lifestyle modifications are helpful, either alone or as an adjuvant to drug treatment, depending on the severity of the disease. First-line drugs are diuretics, calcium antagonists, ACE inhibitors, AT1 blockers and beta blockers. In most cases, combination therapy is appropriate. Possible treatment strategies include stepped care, initial low-dose combination therapy and sequential monotherapy.     

Treatment of arterial hypertension with calcium antagonists

The antihypertensive effect of finoptin (verapamil) and corinfar (nifedipin) and their impact on the hemodynamics and the repolarization complex of the ECG were studied in 52 patients with essential hypertension and 48 patients with secondary arterial hypertension. The calcium antagonists were found to effectively decrease the blood pressure by reducing the peripheral resistance. Verapamil may be recommended for the monotherapy of mild and moderate forms of arterial hypertension, whereas corinfar should be used in cases of marked hypertension and at the third stage of therapy. Patients with electrocardiographic signs of myocardial ischemia show the normalization of the ST segment and a decreased depression of T wave under the impact of corinfar.     

Treatment of hypertension associated with renal arterial occlusive disease

Renal artery stenosis is a common cause of diastolic hypertension. Recent development of arterial reconstructive technics provides the opportunity to cure most patients with renovascular hypertension and to salvage the involved kidney or kidneys.

Resectional therapy provides a second type of treatment when definitive arterial reconstruction is impossible.

Patch graft angioplasty and renal artery bypass are the two most satisfactory technical means of renal revascularization.

Selection of patients with renal artery stenosis for revascularization is primarily a matter of exclusion. Specific contraindications include cerebrovascular insufficiency and coronary artery disease. Eighty per cent of 140 patients having renal revascularization procedures were cured of hypertension.