Razones para iniciar el tratamiento antihipertensivo con doble terapia

Abstract

The physiopathology of hypertension includes alterations in blood volume and an increase in peripheral resistance. Underlying these alterations is an imbalance in the renin-angiotensin-aldosterone system, alterations in the sympathetic nervous system, and an increase in sodium, etc. All these alterations interact in a compensatory fashion. An alteration of one of these mechanisms will give rise to an elevation in blood pressure if one of the other mechanisms does not act to compensate. Consequently, most hypertense patients have more than one dysfunctioning mechanism. This, in turn, makes it difficult to achieve good blood pressure control by using a drug that acts on only one of the altered mechanisms. Consequently, it is not surprising that most patients require a combination of two or three drugs that act on more than one mechanism. Several studies have shown that achieving good blood pressure control in the short term in patients at high cardiovascular risk reduces morbidity and mortality. Both objectives will be more easily achieved if treatment is started with dual combination therapy, especially in patients at high cardiovascular risk and in those requiring the greatest blood pressure reduction to achieve good control of hypertension and its associated morbidity and mortality.