Hypertension: How comorbid disease influences the choice of therapy

Two categories of comorbid conditions affect the choice of therapy for hypertension: compelling indications, where outcomes data show improved survival, and indications where therapies may be beneficial but do not affect survival. In patients with diabetes, low-dose diuretics effectively lower blood pressure, but metabolic derangements may occur. A diuretic may exacerbate urinary incontinence and therefore may not be a first-choice therapy for some older women. Monotherapy is not effective in controlling blood pressures in patients with renal insufficiency. In patients with a history of MI, even those age 85 and older benefit from beta blockade. Lowering blood pressure over a 3- to 5-year period is effective in preventing left ventricular hypertrophy and congestive heart failure.