The multifactorial nature of hypertension: the greatest challenge for its treatment?

Essential hypertension is a polygenic disease involving a major contributio n of various environmental factors. It is therefore not surprising that ant i hypertensive medications, whatever their mechanism(s) of action, only nor malize the blood pressure for a fraction of hypertensive patients when admi nistered as monotherapies. It is unfortunately not possible to predict with any degree of certainty which type of blood pressure-lowering agent is the most appropriate for a given patient. Although very attractive, genetic ma pping is not really helpful in selecting a treatment for any individual pat ient. In most patients the association of two medications having different impacts on the cardiovascular system is necessary to normalize blood pressu re. Fixed-low-dose combinations are becoming increasingly popular as first line treatment as they increase the probability of bringing the patient's b lood pressure under control while minimizing the incidence of dose-dependen t adverse effects. J Hypertens 19 (suppl 3):S9-S16 (C) 2001 Lippincott Will iams & Wilkins.