Single pill combination therapy for hypertension: New evidence and new challenges: Combination Therapy for Hypertension.

Abstract

Hypertension (HTN) continues to be one of the most important risk factors for major cardiovascular events and mortality. The global prevalence of hypertension is approximately 30% among adults over 20 years old. Cardiovascular risk stratification is crucial to determine the most appropriate pharmacological therapeutic strategy for hypertensive patients. Despite the many scales to stratify risk, none is perfect and represents weighted mathematical models to determine risk at 10 years. Reports have identified numerous limitations, and the challenge persists. A practical way to determine CV risk is the clinical approach based on 1) the number of risk factors, 2) the degree of elevation of blood pressure, 3) the presence of target organ damage/DM/CKD, and 4) a history of major cardiovascular events. Currently, it is recommended to start with dual therapy in a single pill (either ACE inhibitors or ARB2 + dihydropyridine calcium channel blockers or thiazide/thiazide-like diuretic); however, many patients could need to start with triple therapy (low or standard doses) if they belong to the high- or very high-risk group with elevation grade 2 or 3 of blood pressure. This article discusses this topic and establishes some practical recommendations for the physician of first contact.