Treatment of Hypertension: Monotherapy or Combination Therapy Monotherapy In Hypertension

Is there a place for monotherapy? Yes, there is a place for monotherapy. According to the Seventh report of the Joint National Committee in 2003 (1) and the European guidelines from 2007 (2) and 2009 (3), the first step in hypertension control is changing lifestyle before initiating medical treatment. According to the baseline blood pressure and the presence or absence of target organ damage and risk factors, it appears reasonable to initiate therapy either with a low dose of a single agent or with a low-dose combination of two agents. If low-dose monotherapy is chosen and blood pressure control is not achieved, the next step is to switch to a low dose of a different agent, or to increase the previous agent to full dose. Combination therapy may be used according to the circumstances (Figure 1) if target blood pressure values are not achieved: systolic blood pressure < 140 mm Hg and diastolic blood pressure < 90 mm Hg in adults and <130/80 in special populations (patients with diabetes, equivalent diseases or chronic renal diseases). Non-pharmacological measures may suffice to normalize blood pressure in patients with grade 1 (mild) hypertension. Grade 2 hypertension may