However, combination therapy was associated with significantly higher rates of discontinuation due to syncope (0.3% versus 0.2%) and renal impairment (13.5% versus 10.2%) compared with ramipril. This reduction is most clearly demonstrated with thiazide diuretics As outlined above for adults aged < 60 years, there is strong, placebo-controlled, clinical trial evidence showing reductions in stroke, MI, heart failure, and in cardiovascular and all-cause mortality with thiazide diuretics (particularly at low doses), in both younger and older patients with hypertension The recommendation backing the use of long-acting dihydropyridine CCBs is supported by the placebo-controlled SYST-EUR trial, which showed statistically significant reductions in stroke (RR, 0.59; 95%CI, 0.41 to 0.83), and strong trends in MI (RR, 0.76; 95%CI, 0.54 to 1.06), in heart failure (RR, 0.75; 95%CI, 0.50 to 1.13) and in cardiovascular death (RR, 0.75; 95%CI, 0.54 to 1.03), consistent with those reductions seen in the thiazide trials The evidence supporting the use of ARBs in this age group is derived chiefly from the aforementioned LIFE trial.Add-on agents should be chosen from first-line options because there is evidence supporting the use of these agents to reduce cardiovascular morbidity and/or mortality as summarized above.Please see similar recommendation above for background and rationale. About one-third of acyclovir in the body is removed by dialysis during a 4-hour hemodialysis session.There is no information specific to administration of VALTREX in patients receiving peritoneal dialysis. (3) One of the essential benefits provided by the ARB plus CCB combination was the excellent end-organ protection. The removal of acyclovir after CAPD and CAVHD is less pronounced than with hemodialysis, and the pharmacokinetic parameters closely resemble those observed in patients with end-stage renal disease (ESRD) not receiving hemodialysis. Select one or more newsletters to continue. Notably, constipation was lower with dual CCB than with NDHP alone. The incidence of heart failure was also lower in chlorthalidone-treated patients than in the other three treatment arms. Thus, generalizability of recommendations to frail elderly is limited. This recommended dose largely based on a meta-analysis that reported greater benefits with low doses compared with high doses of thiazides in preventing cardiovascular events Indirect evidence exists that supports the use of chlorthalidone over hydrochlorothiazide A recently published meta-analysis of 13 randomized controlled trials (n=105,951) Furthermore, there were no differences in rates of myocardial infarction (MI) or deaths between β-blockers and other antihypertensives. *The amount of cherry flavor added is as instructed by the suppliers of the cherry flavor.Dosage recommendations for adult patients with reduced renal function are provided in Alternate dose for immunocompetent patients with less than or equal to 9 recurrences/yearPatients requiring hemodialysis should receive the recommended dose of VALTREX after hemodialysis. As in younger patients, recommendations for preferred therapies were based on consideration of those drugs that have been shown (in level I studies) to reduce both BP and BP-related complications. Ten calcium channel blockers (CCBs) are currently marketed in the United States. It is unclear whether less than full doses of these agents in combination cause worsening renal impairment or hypotension. Thus, CHEP Recommendations continue to state that β-blockers should not be used as first-line monotherapy in patients aged 60 years or older, but may be used in patients younger than 60 years of age, or in those with other compelling indications for β-blockade (such as symptomatic coronary disease, recent MI or congestive heart failure), or in those requiring polytherapy to control their BP.Additionally, the CHEP recommends ACE inhibitors be used with caution as first-line monotherapy in Black Canadian patients, based on an a priori subgroup analysis from ALLHAT, in which rates of stroke (RR 1.40; 95%CI, 1.17 to 1.68) and combined cardiovascular disease (RR 1.19; 95% CI 1.09 to 1.30) were significantly higher in African-American patients treated with an ACE inhibitor than in those African-American patients treated with a thiazide However, the use of β-blockers in the elderly, ACE inhibitors in Black Canadian patients, or α-blockers may be appropriate in selected hypertensive patients with concomitant conditions or in combination therapy.Failure to treat isolated systolic hypertension in the elderly represents an important gap in health care, since hypertension is more prevalent in the elderly.