title: Treatment of systemic hypertension.
abstract: Most patients with high blood pressure (BP) can be managed by using one of 4 classes of compounds: a diuretic, beta blocker, converting enzyme inhibitor or calcium antagonist. It is becoming clear, however, that different patients respond to different drugs and that side effects also vary from 1 patient to another. In many patients in whom 1 drug is not sufficient to lower BP, the combination of a low dose of 2 drugs, particularly a diuretic combined with a beta blocker or a converting enzyme inhibitor, is an effective way of decreasing BP further. An understanding of the mechanisms whereby drugs lower BP and why they are additive with some drugs and not with others is clearly important in the more rational use of drugs. The finding that much lower doses of drugs can be used is also important; the combination of a low dose of 2 drugs may not only be more effective in lowering BP but also have less side effects than a higher dose of a single drug. In patients with more resistant hypertension that is not controlled by 1 or 2 drugs combined, the next logical step is to add a third drug. Before doing this, however, it is important to check that the patient is complying with treatment and to consider secondary causes. Ideally, such patients should be referred to someone with a special interest in high BP as they are more likely to have an underlying cause for their hypertension.
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001581:Benzothiadiazines; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D004039:Diet, Sodium-Restricted; D004232:Diuretics; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D049993:Sodium Chloride Symporter Inhibitors / Q000627:therapeutic use*
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D001581:Benzothiadiazines; D002121:Calcium Channel Blockers; D004232:Diuretics; D049993:Sodium Chloride Symporter Inhibitors