PHARMACOLOGICAL TREATMENT OF SAH: RECENT ADVANCES AND CLINICAL PERSPECTIVES

Abstract

Systemic arterial hypertension (SAH) represents the main modifiable risk factor for cardiovascular disease globally. Pharmacological treatment is crucial for reducing associated morbidity and mortality, having evolved from a sequential approach to the recommendation of initial combination therapy. This narrative literature review, based on a PubMed search focusing on the recent 2023 European Society of Hypertension (ESH) and 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines, aimed to synthesize the current evidence on pharmacotherapy for SAH. The results demonstrate a paradigm centered on the early introduction of dual therapy for most patients, preferably in a single pill (SPC) to optimize adherence. The first-line strategy consists of the combination of a renin-angiotensin system inhibitor (ACEI or ARB) with a calcium channel blocker or a thiazide/analog diuretic. The algorithm continues with triple therapy and, for cases of resistant hypertension, the addition of spironolactone. It is concluded that the current approach to treating hypertension is more pragmatic and effective, prioritizing rapid blood pressure control and treatment adherence through simplified combination regimens.