Hypertension: How comorbid disease influences the choice of therapy - Partfour of a roundtable discussion

Two categories of-comorbid conditions affect the choice of therapy for hype rtension: compelling indications, where outcomes data show improved surviva l, and indications where therapies may be beneficial but do not affect surv ival. In patients with diabetes, low-dose diuretics effectively lower blood pressure, but metabolic derangements may occur. A diuretic may exacerbate urinary incontinence and therefore may not be a first-choice therapy for so me older women. Monotherapy is not effective in controlling blood pressures in patients with renal insufficiency. In patients with a history of MI, ev en. those age 85 and older benefit fi om beta blockade. Lowering blood pres sure over a 3- to 5-year period is effective in preventing left ventricular hypertrophy and congestive heart failure.