Hypertension: Who to treat, to what extent and how?

Hypertension is the modifiable risk factor causing the largest loss in healthy life-years. The risk of cardio-vascular events increases exponentially with the level of blood pressure (BP), starting from 115 mmHg for systolic BP. Out-of-office BP measurements (self-measurements or ambulatory BP measurements) are now preferred for the diagnosis and follow up. In the absence of a preferred indication, antihypertensive treatment is based on thiazide diuretics, calcium channel blockers, angiotensin-converting enzyme inhi-bitors and angiotensin receptor blockers. These treatments are associated with a significant reduction in morbidity and mortality in people with office BP >= 140/90 mmHg (self-measurements >= 135/85 mmHg). For people at high cardiovascular risk, especially those with a history of cardiovascular disease, starting the treatment for an office BP >= 130/80 mmHg is also beneficial (self-measurements >= 130/80 mmHg as well). It is now common to start treatment with half-dose dual therapy, which is more effective and better tolerated than full-dose monotherapy. The clinical effect is assessed at 4 weeks and intensification, if required, is then usually done by switching to the same dual therapy at full-dose for both components. (c) 2023 Societe Nationale Franc,aise de Medecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.