Selecting a Treatment Regimen
Macrovascular Disease
Antiplatelet Therapy
ÎÎThe use of low-dosage aspirin (75-162 mg daily) is recommended for
secondary prevention of CVD (A-1). For primary prevention of CVD, its
use may be considered for those at high risk (10-year risk > 10%) (D-4).
Hypertension
ÎTherapeutic recommendations for hypertension should include
Î
lifestyle modification to include DASH diet (Dietary Approaches to Stop
Hypertension – http://www.nhlbi.nih.gov/health/public/heart/hbp/
dash/new_dash.pdf), in particular reduced salt intake, increased physical
activity, and, as needed, consultation with a registered dietician and/or
CDE (A-1).
ÎÎPharmacologic therapy is used to achieve targets unresponsive to
therapeutic lifestyle changes alone. Initially, antihypertensive agents
are selected on the basis of their ability to reduce blood pressure and to
prevent or slow the progression of nephropathy and retinopathy.
>> ACE inhibitors or ARBs are considered the preferred choice in patients with DM (D-4).
>> The use of combination therapy is likely required to achieve blood pressure
targets, including calcium channel antagonists, diuretics, combined α/β adrenergic
blockers, and newer-generation β-adrenergic blockers in addition to agents that
block the renin-angiotensin system (A-1).
Table 8. Suggested Priority of Initiating Blood PressureLowering Agents
Therapy (Evidence Based)
Evidence Level
Renin-angiotensin-aldosterone system blockers
(ACE inhibitor or ARB)
Calcium channel blockers
1
Thiazide diuretic
β-Adrenergic blocker
Additional Therapy
Aldosterone receptor blockers
Direct renin inhibitor
Selective α1-adrenergic blockers
Central α2 agonists
Direct vasodilators
14
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