Are monotherapies still valuable to the treatment of hypertension?

Arterial Hypertension (AH) has a high prevalence in the population worldwide and represents the most important risk factor for cardiovascular (CV) mortality and morbidity. The optimal treatment of hypertension significantly reduces the rate of myocardial infarction (MI), stroke, heart failure (HF), and chronic kidney disease [1]. Antihypertensive therapy is the cornerstone of treatment in ypertensive patients particularly in those with very high blood pressure (BP) values, moderate to very high global CV risk as well as in those patients with persistently elevated BP values despite lifestyle modifications [2,3]. The European Society of Hypertension/European Society of Cardiology (ESH/ESC) and the American Heart Association/ American College of Cardiology (AHA/ACC) hypertension guidelines suggest several classes of first-line antihypertensive drugs that have shown a measurable preventive role and an acceptable safety profile. As a matter of fact, ngiotensinconverting enzyme inhibitors (ACEIs), angiotensin-receptor blockers (ARBs), dihydropyridine calcium-channel blockers (CCBs), and thiazide diuretics (TDs) or thiazide-like diuretics are considered the first-line choice. The use of beta-blockers should be restricted to patients with specific clinical indications (e.g. ischemic heart disease, HF, etc.) [2,3]. Finally, in patients with resistant hypertension, the use of mineralocorticoids receptor antagonists and α-adrenergic receptor modulators can be considered. All the major guidelines suggest the extensive use of combinations of the first-line drugs as initial treatment or as a second step in some selected populations of patients initially treated with monotherapy.