[Why and when to begin pharmacological treatment with dual-therapy]

Hypertension is a syndrome in which, in addition to the elevation of blood pressure, there is micro-, macrovascular and kidney disease. Several mechanisms are interrelated in the physiopathology of hypertension, such as, the volume, renin-angiotensin system, and the sympathetic nervous system. These factors make it difficult to achieve blood pressure control with only a single drug. The vast majority of patients will require the combination of 2 or 3 drugs acting synergistically to increase the rate of response rate to treatment, and improve blood pressure control. Recent studies show that this blood pressure control must be achieved as soon as possible, with dual therapy being the first choice, particularly in high cardiovascular risk patients, and in patients who need greater reductions in blood pressure to achieve the goal.