Study note
MedicineCardiology

Additional antihypertensives and cardiovascular risk reduction

THE CONTEXT
Combined adrenergic blockers and other vasodilators provide additional antihypertensive options; antiplatelet therapy and statins address cardiovascular risk.

Combined β- and α-adrenoceptor antagonists

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Labetalol and carvedilol combine β- and α-adrenoceptor antagonism and are sometimes more effective than pure beta-blockers.
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Listed doses are labetalol 200 mg–2.4 g daily in divided doses and carvedilol 6.25–25 mg twice daily.
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Labetalol can be administered as an infusion in malignant phase hypertension.

Other vasodilators

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α1-adrenoceptor antagonists include prazosin 0.5–20 mg daily in divided doses, indoramin 25–100 mg twice daily and doxazosin 1–16 mg daily.
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Hydralazine 25–100 mg twice daily and minoxidil 10–50 mg daily act directly on vascular smooth muscle.
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Listed adverse effects include first-dose and postural hypotension, headache, tachycardia and fluid retention.
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Minoxidil also increases facial hair; the source therefore describes it as unsuitable for female patients.

Antiplatelet therapy

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Antiplatelet therapy reduces cardiovascular risk but can cause bleeding, particularly intracerebral haemorrhage, in a small number of patients.
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Benefits are thought to outweigh risks in hypertensive patients aged at least 50 years with well-controlled blood pressure and either target organ damage, diabetes, a 10-year coronary artery disease risk of at least 15%, or a 10-year cardiovascular disease risk of at least 20%.

Statins

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Treating hyperlipidaemia can substantially reduce cardiovascular risk.
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Statins are strongly indicated in established vascular disease, or in hypertension with a cardiovascular disease risk of at least 10% over 10 years.
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