Expanding role for combination drug therapy in the initial treatment of hypertension?

摘要

Both the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and the European Society of Hypertension have recommended initiating antihypertensive therapy with a single agent in patients with stage 1 or grade 1 hypertension (systolic < 160 mm Hg and diastolic < 100 mm Hg). Although the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends initiating drug therapy with a thiazide-type diuretic for "most patients," the report acknowledges that selection of an initial single agent may be influenced by patient demographics, comorbidities, and physiological profiling (eg, hemodynamic values and renin-sodium profiling). Initiating drug therapy with > 1 agent is recommended for patients with blood pressure >20/10 mm Hg above goal or for patients with grade 2 or grade 3 hypertension (systolic >=160 mmHg and/or diastolic >=100 mmHg) or high overall cardiovascular risk where early blood pressure control may be desirable.