Drug treatment for hypertension

Factors to be considered when deciding on drug treatment for hypertension: the severity of hypertension presence of organ damage comorbidities and current medication (table ) personal data, such as age and gender drug costs evidence about prognosis. The average reduction in blood pressure (BP) is similar with equivalent doses of ACE inhibitors, angiotensin-receptor blockers (ARBs), beta-blockers, diuretics and calcium-channel blockers, and they are all well tolerated in small doses. Treatment with these agents decreases the incidence of cardiovascular events . Adverse effects, particularly those of diuretics, beta-blockers and calcium-channel blockers, are more likely with higher doses. BP can be lowered with the renin inhibitor aliskiren, aldosterone antagonists, the alpha blocker prazosin and the centrally acting clonidine and moxonidine which regulate the function of the sympathetic nervous system; however, there is no scientific evidence on their effect on cardiovascular events. The efficacy and tolerability of drug treatment can be improved by using a combination of several drugs in small doses. A combination of two drugs lowers BP more effectively than the doubling of the dose of one drug. Most patients will require a combination of drugs in order to achieve the treatment goal.The treatment is started directly with a drug combination (2–4 drugs) in high-risk patients and when BP is markedly elevated (> 180/110 mmHg)