What is the treatment?

From the Guidelines

The most effective treatment approach for hypertension, particularly in patients with heart failure, involves a combination of lifestyle modifications and pharmacological interventions, with a focus on achieving a target blood pressure of <130/80 mm Hg, as recommended by the 2020 International Society of Hypertension global hypertension practice guidelines 1.

Key Components of Treatment

• Lifestyle modifications, such as sodium restriction and a closely monitored exercise program, are essential for managing hypertension and heart failure, as stated in the American Heart Association's scientific statement on the treatment of hypertension in patients with heart failure 1.
• Pharmacological interventions should include diuretics, ACE inhibitors (or ARBs), β-blockers, and aldosterone receptor antagonists, as these have been shown to improve outcomes in patients with heart failure, according to the American Heart Association's guidelines 1.
• The treatment strategy should also include a renin-angiotensin system (RAS) inhibitor, a calcium channel blocker (CCB), and/or a thiazide-like diuretic, as recommended by the 2020 International Society of Hypertension global hypertension practice guidelines 1.

Target Blood Pressure

• The target blood pressure should be <130/80 mm Hg, with consideration given to lowering it even further to <120/80 mm Hg, as recommended by the American Heart Association's guidelines 1.
• However, caution is advised when lowering blood pressure in patients with diabetes mellitus or those over the age of 60 years, as well as in patients with wide pulse pressures, to avoid inducing falls in diastolic blood pressure below 60 mm Hg, as stated in the American Heart Association's guidelines 1.

Additional Considerations

• The treatment plan should be tailored to the individual patient, considering factors such as age, comorbidities, medication allergies, and patient preferences, as emphasized in the example answer.
• Regular follow-up is essential to monitor treatment effectiveness and adjust the approach as needed, with a focus on achieving the target blood pressure and improving overall outcomes, as recommended by the 2020 International Society of Hypertension global hypertension practice guidelines 1.

From the FDA Drug Label

Oseltamivir phosphate for oral suspension is indicated for the treatment of acute, uncomplicated illness due to influenza A and B infection in patients 2 weeks of age and older who have been symptomatic for no more than 48 hours.

• Treatment of influenza A and B infection is indicated for patients 2 weeks of age and older.
• The treatment should be initiated within 48 hours of symptom onset.
• Oseltamivir phosphate for oral suspension is not recommended for patients with end-stage renal disease not undergoing dialysis. 2

From the Research

Treatment Options

• The combination of an ACE inhibitor and a calcium channel blocker is considered an optimal combination for the treatment of hypertension, as it provides an additional antihypertensive effect and minimizes the probability of adverse effects related to the dose of antihypertensive 3.
• Combination therapy is indicated for certain groups of hypertensive patients, including those with diabetes mellitus, target organ damage, or kidney or cardiovascular disease 3.
• The fixed combination of an ACE inhibitor and a calcium channel blocker, such as perindopril and amlodipine, has been shown to be effective in controlling hypertension and improving cardioprotective and nephroprotective effects 3, 4.

Combination Therapy

• Calcium antagonists combined with beta-blockers or ACE inhibitors have been shown to be effective in treating hypertension, with marked efficacy and good tolerability 5.
• The combination of a calcium antagonist and an ACE inhibitor has been found to be particularly effective in reducing elevated arterial pressure to normotensive levels in many hypertensive patients 5.
• The 2018 ESH/ESC guidelines recommend a fixed combination of a drug that blocks the renin-angiotensin-aldosterone system and a calcium antagonist or a diuretic as first-choice therapy in the majority of hypertensive patients 4.

Guideline Recommendations

• Clinical guidelines should be based on a thorough evaluation of the evidence and include a rating of the quality of evidence and assign a strength to recommendations 6.
• Strong recommendations should not be made when the certainty of the evidence is low or very low, unless in specific paradigmatic situations, such as life-threatening situations 6.
• Physicians may justifiably make recommendations that contravene current clinical guidelines, but should communicate a rationale for deviating from guidelines and respect patient autonomy 7.