Académique Documents
Professionnel Documents
Culture Documents
• Name : Prof. DR. Dr. Idrus Alwi SpPD, K-KV, FACC, FESC,
FAPSIC, FINASIM, FACP.
• Current Position : President of Indonesian Society of
Internal Medicine
Prof. Idrus Alwi MD, PhD, FINASIM, FACC, FESC, FAPSIC, FACP
Indications
ESH/ESC: Antihypertensive Treatment Preferred Drug
- ACE Aldo-
Diuretic ARB CCB
blocker inhibitor antagonist
Heart failure
• • • • •
Post-MI
• • •
Angina
pectoris • •
Diabetes
• •
Renal
dysfunction • •
Previous
stroke
Any blood pressure lowering agent
Beta-Blocker No Beta-Blocker
HR, 0.92 (95% CI, 0.79-1.08); HR, 0.90 (95% CI, 0.79-1.03);
P = .31 P = .14
No β-blocker β-blocker
No β-blocker
β-blocker
Follow-up, mo
Follow-up, mo
1. Bisoprolol
4. Nebivolol
-10
-20
-20
p=0.0006
-30
-29
p=0.0049
-40 -36
p=0.0001
-44 -44
-50 p<0.0001 p=0.0011
0 2 4 6 8 10 12 28 30 32 32 32
20
82% of 65% of
10
patients patients 5
10
enalapril (mg/d)
7.5
5
3.75
2.5
1,25 bisoprolol (mg/d)
10
7.5
5
3.75
2.5
1,25
20 bisoprolol (mg/d)
10
5
enalapril (mg/d)
Overall tolerability to target doses was comparable. The
APLA AP LA
n=10,878 n=10,166 n=712
ACEi or ARB (%) 49.2 48.3 62.2
ACE Inhibitor (%) 36.3 35.5 47.8
Angiotensin II Receptor Blocker (%) 15.0 14.9 16.2
Aldosterone Receptor Antagonist (%) 21.5 20.6 34.1
Compelling Indications
The current Guidelines reconfirm that diuretics (including
thiazides, chlorthalidone and indapamide), beta-blockers,
calcium antagonists, angiotensin converting enzyme
(ACE) inhibitors and angiotensin receptor blockers are all
suitable for the initiation and maintenance of
antihypertensive treatment, either as monotherapy or in
some combinations.
Mancia G, et al. J Hypertens 2013;31:1281–1357
JAMA. doi:10.1001/jama.2013.284427
Predominant
Organ Physiological effect of stimulation
adrenoceptor
2 Vasodilatation
75/1
1/2 Selectivity Ratios
35/1 35/1
20/1
1/2
-1/50
-1/300
ICI
118,551
Beta-blockers vs.
Cardiovascular
Stroke Total mortality
disease
Diuretics 0.92 [0.55, 1.54] 1.13 [0.99, 1.28] 1.04 [0.91, 1.19]
Calcium channel
1.24 [1.11, 1.40] 1.18 [1.08, 1.29] 1.07 [1.00, 1.14]
blockers
RAS inhibitors 1.30 [1.11, 1.53] 1.00 [0.72, 1.38] 1.10 [0.98, 1.24]
Wiysonge CS, et al. Cochrane Database Syst Rev 2012, Nov 14,11:CD002003.doi
Antihypertensive class effect on peripheral SBP minus central SBP