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P. Keerthi Priya*, N. Sai Kavya, S. Sunilkumar, M. Keerthana, V. Sarala, V.C. Chanukya, A. Sandeep, G. Dharani, N. Ramu and B. Bhargavi


Background: Hypertension is a complex syndrome of multiple hemodynamic, neuroendocrine and metabolic abnormalities. It is the most associated co-morbidity in diabetic and CKD patients. The objective of this study is to analyze the changes undergone in the treatment strategy of hypertension in the last two decades (20000 – 2020). Methods: Systematic literature covering various databases like DOAJ, PUBMED, EMBASE, IHJ (Indian heart journal), Google scholar. we applied a staged search approach, where each search was undertaken only if the previous one didn’t yield high-quality results. we included all the studies evaluating the epidemiology, prevalence, treatment of hypertension (monotherapy, combination therapy - two-drug therapy, three-drug therapy, four-drug therapy, FDC – fixed-dose combination), clinical guidelines of hypertension, original research papers or articles. Results: From the through screening of the included articles, differences between the JNC-7 and JNC-8 guidelines for hypertension were sought out for treatment strategies in the respective years from 2000 to 2020 were found. In past years single drug treatment like beta-blockers was given which is switched to Angiotensin-converting enzyme inhibitors and finally to calcium channel blockers. The usage of thiazide diuretics is not suggested in patients with gout where alternative therapy should be found. Coming to combination therapy like 2-drug therapy was mostly preferred over 3 or 4 drug therapies as they are very efficient in achieving the target with minimal side effects and also less time-consuming. ACE inhibitors + thiazide diuretics were the mostly used fixed-dose combination in the time of 2005 – 2008 which has been slowly replaced with beta blockers+calcium channel blockers and then switched to calcium channel blockers+angiotensin converting enzyme inhibitors in patients with comorbidities. Conclusion: The change which is observed in these two decades is a beneficial one and many benefits were also observed such as increased sensitivity to the drug, decreased mortality rates, and decreased adverse drug reactions were observed. Adherence to the National list of essential medicines was mostly with calcium channel blockers followed by beta-blockers and the least was diuretics. Finally, the rationale for the guidelines is being increased as the years pass, however, in certain regions complete adherence to guidelines was not found and is yet to be increased.

Keywords: .

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