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Kidney Disease
The target BP in chronic kidney disease is set at 130/80. This will retard the progression of renal function. The drugs recommended are the ACEI/ARBs. These can be given provided the serum creatinine levels do not exceed 35 per cent above baseline. Among these some studies have shown that candesartan and ibesartan have better effects.
Cerebrovascular Disease
No firm conclusions are arrived at as to the pros and cons of sudden lowering of BP in acute strokes. The consensus is that a BP of about 160/100 would be appropriate till the condition is stabilized. The frequency of recurrent strokes can lessened by the use of ACEI and Thiazides.
Systolic Hypertension
Almost all hypotensives can be used to attain the target BP in this condition. However, the therapy must be carefully monitored and should be slow.
Elderly
Newer studies have shown that cardiovascular complications can be reduced in those over 80 years, by control of BP. However, a few precautions are necessary when treating the elderly. One of the major problems is the occurrence of postural hypotension, because of which, drugs which cause this effect should be avoided. Treatment should progress carefully and gradually. The preferred drugs are low dose diuretics and dihydropyridine calcium antagonists.
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