Med. praxi. 2024;21(1):13-16 | DOI: 10.36290/med.2024.006

How to initiate treatment of arterial hypertension

MUDr. Alena Hrubeš Krajčoviechová, Ph.D.

Centrum kardiovaskulární prevence 1. LF UK a Fakultní Thomayerovy nemocnice, Praha

The primary aim of antihypertensive treatment is, beside optimal blood pressure control, to reduce cardiovascular risk and all-cause mortality. Numerous multicenter trials have demonstrated that angiotensin-converting enzyme inhibitors (ACE-I) possess cardioprotective and long-term survival benefits beyond the effect of blood pressure reduction. A meta-analysis of randomized control trials in hypertension which aimed to compare the effect of ACE-I and AT1 blockers on clinical outcomes, demonstrated that while ACE-I reduce all-cause mortality, there was no effect on all-cause mortality with AT1 blockers. The pathophysiological basis of the unique ACE-I properties is the increase in level of circulating bradykinin and a decrease in stimulation of AT2 and AT4 receptors. Thus, ACE-I (and particularly perindopril) play a critical role in maintaining endothelial continuity, reducing the progression of atherosclerosis and left ventricular remodeling. Nowadays, combination therapy, preferably fixed-dose, represents the best practice for safe, effective, well-adhered and rapid blood pressure control, and should be considered in initial management of majority hypertensive patients. Combination of ACE-I and calcium channel blockers is very convenient to use due to its good tolerability, complementary effect on blood pressure reduction and excellent evidence of long-term cardiovascular protection.

Keywords: hypertension, blood pressure control, fixed combination, CV protection.

Accepted: February 23, 2024; Published: March 6, 2024  Show citation