michigan hypertension core curriculum - State of Michigan

RAS antagonists slow CKD progression, profoundly reduce proteinuria and, at least in some though not
all studies, appear to provide protection against cardiovascular events that is not directly linked to BP
reductions. For example, the RENAAL trial was an RCT that randomized 1513 patients with diabetes
and nephropathy to losartan or placebo. 10 The investigators found a 16% relative risk reduction in the
primary composite endpoint of doubling of the serum creatinine, end-stage renal disease or death.
Angiotensin converting enzyme inhibitors and ARB are the drugs of choice in recurrent stroke
prevention. In RCT, the use of ACE inhibitors or ARB has resulted in 30-50% relative risk reductions in
the risk of recurrent stroke. 11-13 Nevertheless, these agents will very likely be utilized along with other
antihypertensive drug classes to obtain and persistently maintain BP control.
For hypertensive patients with any of the co-morbid conditions for which specific drugs are
indicated, BP control to goal is, however, an absolute necessity to confer maximal target-organ
protection while preventing undesirable CVD-renal events. Familiarity with the compelling indications
for anti-hypertensive medications allows a provider to provide optimal care and to reduce preventable
morbidity and mortality.
Key Points:
1.) Certain drug classes offer improved cardiovascular and renal morbidity and mortality beyond
simple BP control in patients with specific co-morbidities; some drugs with compelling indications,
however, do not necessarily confer any special benefit to patients with a given co-morbidity but have
rather been proven safe to use in high-risk patients with a given co-morbidity (e.g., diuretics in heart
failure)
2.) ACE inhibitors, beta-blockers and aldosterone antagonists are the drugs of choice in patients
with congestive heart failure with systolic dysfunction.
NKFM & MDCH 183