The multifactorial nature of hypertension: the greatest challenge for its treatment?
Essential hypertension is a polygenic disease involving a major contribution of various environmental factors. It is therefore not surprising that antihypertensive medications, whatever their mechanism(s) of action, only normalize the blood pressure for a fraction of hypertensive patients when administered as monotherapies. It is unfortunately not possible to predict with any degree of certainty which type of blood pressure-lowering agent is the most appropriate for a given patient. Although very attractive, genetic mapping is not really helpful in selecting a treatment for any individual patient. In most patients the association of two medications having different impacts on the cardiovascular system is necessary to normalize blood pressure. Fixed-low-dose combinations are becoming increasingly popular as first line treatment as they increase the probability of bringing the patient's blood pressure under control while minimizing the incidence of dose-dependent adverse effects.
Waeber
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Division of Clinical Pathophysiology and Medical Teaching, University Hospital, Lausanne, Switzerland. bwaeber@chuv.hospvd.ch
Brunner
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D000806:Angiotensin-Converting Enzyme Inhibitors / Q000592:standards / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000592:standards / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects / Q000235:genetics; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005060:Europe / Q000453:epidemiology; D018740:Genetic Heterogeneity / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology* / Q000235:genetics; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014486:United States Food and Drug Administration; D014944:World Health Organization
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents