One of my patients who was in ALLHAT, and is now on amlodipine (or lisinopril), is coming to see me next week. What should I do with his antihypertensive regimen?
The choice of antihypertensive medication has to be made after reviewing the overall clinical situation of each patient and the presence of co-morbid conditions that may require a particular agent. If your patient is taking amlodipine (or lisinopril) only, and the blood pressure is not controlled, you may consider adding a diuretic. In addition, many patients will require multi-drug therapy, and diuretics should be considered as a part of any combination antihypertensive regimen. If your patient is taking amlodipine (or lisinopril) only, and the blood pressure is controlled, you may consider changing him/her to a diuretic because the ALLHAT results tell us that diuretic therapy is superior in preventing one or more forms of cardiovascular disease, and therefore should be the drug of choice for first-step antihypertensive therapy. You will, of course, need to follow the patient to ensure that blood pressure remains controlled.
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