[Pharmacologic treatment of patients with arterial hypertension. Parameters to be considered when choosing a...

The decision to treat, or not treat, uncomplicated mild hypertension should be based on a formal estimate of absolute cardiovascular risk and not on an arbitrary blood pressure threshold. The decision to initiate pharmacologic treatment requires consideration of the degree of blood pressure elevation, the presence of target organ damage, and the presence of clinical cardiovascular disease or other risk factors. Special considerations include demographic characteristics, concomitant diseases that may be beneficially or adversely affected by the antihypertensive agent chosen, quality of life, cost, and use of other drugs that may lead to drug interactions. Diuretics, beta-blockers or ACE inhibitors may be used as first-step drug therapies for the treatment of uncomplicated hypertension. Genetic factors may contribute to interindividual differences in responses to antihypertensive drug therapy. Knowledge of polymorphic variation in these genes will help to predict individual patients' blood pressure responses to antihypertensive drug therapy and may also provide new insights into molecular mechanisms responsible for elevation of blood pressure.