Selecting a Treatment Regimen
Macrovascular Disease Antiplatelet Therapy
ÎThe 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 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).
ÎPharmacologic 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 Pressure- Lowering Agents
Therapy (Evidence Based)
Renin-angiotensin-aldosterone system blockers (ACE inhibitor or ARB)
Calcium channel blockers Thiazide diuretic β-Adrenergic blocker Additional Therapy Aldosterone receptor blockers
Direct renin inhibitor Selective α1
Central α2 Direct vasodilators
-adrenergic blockers agonists
1 Evidence Level
4
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