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Prehypertension: A Case in Favor of Early Use of Diuretics

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Book cover Prehypertension and Cardiometabolic Syndrome

Part of the book series: Updates in Hypertension and Cardiovascular Protection ((UHCP))

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Abstract

Blood pressure (BP) thresholds to diagnose hypertension and to guide therapy have faced ups and downs in recent years. As anticipated by this chapter, the recently released American College of Cardiology and American Heart Association guidelines of hypertension promoted the full range of diastolic BP of prehypertension to hypertension (≥80 mmHg), and established that systolic BP ≥ 130 mmHg is also a criterion to diagnosis hypertension. Meta-analyses identified an unequivocal benefit of BP-lowering drugs in preventing major cardiovascular events in patients with prehypertension. The SPRINT trial added another piece of evidence that treatment with a systolic BP goal below 120 mmHg reduces the incidence of major cardiovascular events and all-cause mortality. Diuretics, particularly chlorthalidone, are the drugs with the best record in terms of prevention of major cardiovascular outcomes in well-designed and unbiased clinical trials. The two more relevant adverse effects of thiazide diuretics are linked, since hypokalemia is the major cause of blood glucose increasing. The association of potassium-sparing agents is the more rational approach to prevent both adverse effects, contributing also with some BP-lowering effect.

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Authors and Affiliations

  1. Division of Cardiology, Hospital de Clínicas de Porto Alegre, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

    Flávio Danni Fuchs

  2. Graduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

    Sandra Costa Fuchs

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Correspondence to Flávio Danni Fuchs .

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Editors and Affiliations

  1. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Reuven Zimlichman

  2. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA

    Stevo Julius

  3. Emeritus Professor of Medicine, University of Milano-Bicocca, Milan, Italy

    Giuseppe Mancia

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Fuchs, F.D., Fuchs, S.C. (2019). Prehypertension: A Case in Favor of Early Use of Diuretics. In: Zimlichman, R., Julius, S., Mancia, G. (eds) Prehypertension and Cardiometabolic Syndrome. Updates in Hypertension and Cardiovascular Protection. Springer, Cham. https://doi.org/10.1007/978-3-319-75310-2_40

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