New York, June 28, 2000 (Praxis Press) Within a few weeks of initiating antihypertensive therapy, physicians often escalate the dosage because of insufficient result, or discontinue the medication because of its perceived adverse side effects. Some studies suggest that hypertension is not an asymptomatic condition and may be responsible for some adverse effects. In a parallel-group clinical trial with randomized participants starting with a 20-mg daily dosage of the angiotensin-converting enzyme inhibitor quinapril, Flack and colleagues increased the drug titration every 2 weeks for the fast group, and every 6 weeks for the slow group (see paper). The study determined that the slower-dose escalation of quinapril affords higher blood pressure (BP) control rates and less severe adverse events. The findings also suggest that hypertension causes unpleasant symptoms as patients with lower BP tolerate treatment better than placebo. Use slow-dose escalation for your patients starting antihypertensive medication.

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