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Therapeutic guidelines for the treatment of essential high blood pressure Volume 22, issue 3, juillet-août-septembre 2003

Author
Service de médecine interne et thérapeutique, Hôpital Broussais, AP‐HP, 96, rue Didot, 75014 Paris

The target blood pressure set by the ANAES for hypertensive subjects of less than 65 years of age is below 140\90 mmHg. Observation of lifestyle and dietetic rules constitutes the first stage of treatment and must be subsequently maintained in order to improve the efficacy of the drugs prescribed and favourably influence the overall cardiovascular risk. This treatment must always begin with single‐drug treatment. The choice from among the 7 therapeutic classes grouped together in "treatment baskets" is precisely standardised. Basket 1 involves CEI, beta blockers and Ara II, basket 2 calcium antagonists and diuretics. Efficacy and safety depend on the pharmacological class, but not on the treatment basket. Treatment is to be adapted according to target blood pressure and safety. With the knowledge that prescription of a second active substance is the rule in a great majority of hypertensive subjects in order to achieve the blood pressure targets, this second drug will be selected from among one of the classes of antihypertensives belonging to the other treatment basket. The rules to be observed in increasing the dosage and\or combining more than 2 drugs, in addition to monitoring the patients according to the adverse events specific to the different classes are described in detail.