[Treatment of moderate hypertension: monotherapy or combination?].
The treatment of hypertension must fall within a strategy of the early and strict control of blood pressure levels. Only actual normalisation of blood pressure can offer long term benefit regarding the incidence of cardiovascular morbidity and mortality. While major studies undertaken up to now have already proven the benefit of treatment using classical drugs as monotherapy, it is now necessary to offer all young hypertension patients, even mild, with strict control of levels, a non-pharmacological action on risk factors, and a choice of treatments ensuring no loss of part of the prognostic benefit as a result of persistence or worsening or sub-clinical metabolic disorders. It seems logical, when first-line monotherapy is selected from among the five major drug groups recommended, is neither perfectly effective nor perfectly tolerated, and risks worsening a metabolic disorder in the long term, to use a combination of hypotensive drugs. This should enable blood pressure control in 80 to 90% of cases, and improved acceptability, a major factor in treatment compliance. It is reasonable to hope, in the long term, that the use of a combination of lower doses than as monotherapy, will ensure less interference with major metabolic, endocrine and vascular functions, leading to a further improvement in the prognosis of treated hypertension.
Krivitzky
A
A
Service de Médecine Interne, Hôpital Avicenne, Bobigny.
Nguyen
G
G
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D011247:Pregnancy
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics
Traitement de l'HTA modérée: monothérapie ou association?