Concluding remarks. Pursuit of the optimal outcome in hypertension.

Achieving the optimal outcome in hypertensive patients requires the selection and use of appropriate strategies to lower the blood pressure and reduce the patient's risk of cardiovascular events such as stroke and coronary heart disease. It also requires ongoing monitoring of the patient to ensure that the desirable end-points of treatment are being met, and that the heart, kidneys and other sites are being effectively protected from potential complications. Current guidelines on the treatment of hypertension continue to emphasise the use of low dose diuretics as appropriate first-line therapy whenever pharmacological intervention is indicated, except where there are positive indications (e.g. coexisting congestive heart failure or diabetic nephropathy) for other classes of drugs. Diuretics have repeatedly been shown to reduce the morbidity and mortality associated with hypertension, both in the elderly and in younger adults, and their combination with other antihypertensive agents (when clinically indicated) permits the use of lower total dosages. The thiazide-related diuretic indapamide has been reported to have a number of advantages over the thiazides, including minimal or no adverse influence on plasma lipids and glucose metabolism, or on kidney function in patients with renal insufficiency. It has also been found to produce regression of left ventricular hypertrophy, which is now accepted as an important objective of antihypertensive therapy. The recently developed sustained release (SR) formulation of indapamide allows use of a lower daily dosage of the drug, thereby improving its efficacy:safety ratio in comparison with immediate release formulations. Clinical studies have confirmed the efficacy of indapamide SR 1.5 mg daily in lowering elevated blood pressure, and this formulation can be considered an appropriate choice whenever a diuretic is indicated for the treatment of hypertension, including elderly hypertensives and, because of its metabolic 'neutrality', hypertensive patients with diabetes.