Hypertensive

Treatment to) in patients with hypertension Grade I or II, it is recommended to initiate treatment with a single drug. If hypertensive patient has a hipercinetico syndrome, the best option is a beta blocker, and is discouraged the use of vasodilators such as the calcium antagonists or blockers alpha since they exacerbate the circulatory hipercinesia. In patients suspected expansion of the extracellular space (especially women) the best option is the diuretic treatment as mono therapy, they are less effective beta blockers and are contraindicated vasodilators worsening fluid retention and expansion of the intravascular space. ACE inhibitors can be equally effective. The use of calcium as drugs of first choice is preferable in elderly with systolic hypertension. (b) the patient with hypertension grade III, necessarily requires the use of several drugs to achieve efficient control of high blood pressure. In this way is preferred to start treatment with beta blockers and diuretics (thiazides and) potassium-sparing). If he is not achieved effective control of the tensional figures can add an ACE inhibitor.

When cannot be normalization of the tensional figures (minoxidil, hydralazine, prazosin) vasodilators that reduce vascular resistances can be used. The calcium antagonists may be used in this type of patients when unable to control high blood pressure with drugs as set forth two or because it has to suspend his administration by undesirable side effects such as: attack of gout (thiazides), asthma or heart failure (beta blockers) or persistent cough (ACE inhibitors). Anta gonistas calcium can also produce undesirable side effects (oedema, facial flushing) that can force its suspension or change by another drug of different familia.Como general conclusion we can say that the treatment of the hypertensive patient must be individualized do take into account age, clinical, hemodynamic conditions and side effects of drugs. (c) the patient with hypertension Grade IV, constitutes an emergency or hypertensive urgency, so his treatment required hospitalization and immediate therapy.

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