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41 PRACTICAL QUESTIONS AND ANSWERS ABOUT HYPERTENSION AND HYPERCHOLESTEROLEMIA - 2008

DRUG TREATMENT FOR HYPERTENSION PREVIOUS QUESTION  QUESTIONS  NEXT QUESTION
  • The planning of the antihypertensive treatment strategy is made by the physician specifically for each patient (individualization of treatment). The choice of the best available drug depends on the presence of various other parameters, such as comorbidities (ie coronary heart disease, renal disease, diabetes mellitus, uric acid arthritis, asthma, chronic bronchitis), previously used drugs and also other factors like age, gender, lifestyle etc. In other words the antihypertensive treatment is tailored according to each individual's needs.
  • As a rule, the antihypertensive therapy is lifelong. If the treatment is for any reason discontinued arterial hypertension soon reappears (within a few days or weeks) or, in some cases, after months.
  • Upon drug treatment commencement, the physician will also specify the target (blood pressure level) of therapy (please see: "How much should blood pressure be lowered?")
  • The antihypertensive treatment usually begins with one single drug (monotherapy). In cases of very high blood pressure levels or when other comorbidities exist (diabetes mellitus, previous cardiovascular event etc.) the physician may decide to use from the beginning a combination of two different drugs (sometimes combined in one pill).
  • In order to get the maximum antihypertensive effect of a drug its continual use for at least 3 to 4 weeks is required. Therefore, one week's treatment is not sufficient to judge the efficacy of a drug. For that reason, the rush to increase drug dose or to switch to a different drug is not advised.
  • The decision whether to continue or to reconsider the treatment strategy by increasing the dose of the drug, adding a second drug or changing the prescribed drug is based on the achieved level of blood pressure as well as on the development of side effects. These may present themselves as clinical symptoms or alterations in metabolic parameters.
  • The optimal control of blood pressure by one, and only one, drug is achieved in less than half of the patients. In most cases in order to achieve the blood pressure target a combination of two or even more drugs is required.
  • The drugs with a prolonged duration of action are preferred when planning the treatment strategy because they allow a single dose per day regimen, increasing the patient's comfort and compliance with the therapy. In some difficult cases drugs may be prescribed twice a day and occasionally three times per day.
  • Antihypertensive drugs should be taken every day, and as a general rule, early in the morning immediately after waking up.

WRITING GROUP
G. Stergiou, Chairman
A. Achimastos
E. Andreadis
I. Avramopoulos
M. Elissaf
N. Karatzas
T. Mountokalakis
D. Papadogiannis
K. Siamopoulos
E. Varsamis
K. Vemmos
D. Vlahakos