Nouvelles stratégies pour le contrôle de l'hypertension: preuves supplémentaires en faveur des associations faiblement dosées

Hypertension control remains inadequate around the world with many hypertensive people untreated and many treated patients remaining hypertensive. Normalisation of the systolic blood pressure presents the greatest challenge to the physician even though it is the dominant predictor of cardiovascular risk in hypertensive subjects. This is particularly true in people over the age of 50, reflecting the progressive "stiffening" of the arteries with advancing age. New strategies are needed to combat this challenge and the American, European and International guidelines in 2003 all recommend the use of more intensive therapy using combination therapy for the majority of patients. Furthermore, these guidelines all approve the use of fixed dose combinations, particularly fixed low-dose combinations, to improve compliance with therapy and blood pressure control, and to reduce costs. The American and European Guidelines approve the use of fixed low dose combinations to initiate the drug treatment of hypertension. The fixed low-dose combination of perindopril 2 mg and indapamide 0.625 mg, exemplifies all the benefits to be obtained with this strategy. Studies so far have confirmed the superior efficacy of this perindopril/indapamide combination in lowering blood pressure, particularly systolic blood pressure, and in slowing or reversing the progression of target organ damage, including left ventricular hypertrophy and albuminuria. These benefits appear to reflect actions on both large central arteries and on the microcirculation. Effective use of this fixed combination of perindopril and indapamide has the potential to reduce the growing burden of blood pressure related disease worldwide.