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Therapeutic Algorithm for Hypertension Treatment

Risk Classification

Low Risk
Lifestyle Modifications (3-6 months)
If ineffective
Monotherapy (one of ACE inhibitors, ARBs, Calcium channel blockers, Thiazide diuretics)
If ineffective
Dosage Increase
If ineffective
Drug Switch
If ineffective
Dual Therapy (ACE inhibitor/ARB + Calcium channel blocker/Thiazide diuretic)
Moderate Risk
Dual Therapy (ACE inhibitor/ARB + Calcium channel blocker/Thiazide diuretic)
If ineffective
Dosage Increase
If ineffective
Drug Switch
If ineffective
Triple Therapy (Dual therapy + the missing drug between Thiazide diuretic and Calcium channel blocker)
High Risk
Dual Therapy (ACE inhibitor/ARB + Calcium channel blocker/Thiazide diuretic)
If ineffective
Dosage Increase
If ineffective
Drug Switch
If ineffective
Triple Therapy (Dual therapy + the missing drug between Thiazide diuretic and Calcium channel blocker)
If ineffective
Quadruple Therapy (Triple therapy + Spironolactone or Beta-blockers or other second-line drugs)
Very High Risk
Triple Therapy (Dual therapy + the missing drug between Thiazide diuretic and Calcium channel blocker)
If ineffective
Quadruple Therapy (Triple therapy + Spironolactone or Beta-blockers or other second-line drugs)
If ineffective
Renal Denervation
    References
  1. Williams B, et al. 2023 ESH Guidelines for the management of arterial hypertension. Journal of Hypertension. 2023;41(6):1113-1200.
  2. Muiesan ML, et al. Linee guida ESH 2023: la scelta della terapia antiipertensiva. OPT-IN. 2024;1:13-20.
  3. McEvoy JW, et al. Linee guida ESC 2024 per la gestione della pressione arteriosa elevata e dell’ipertensione. Giornale Italiano di Cardiologia. 2024;25(11 Suppl. 1):e1-e107.
  4. Società Italiana dell’Ipertensione Arteriosa. Linee Guida ESH 2023 per il trattamento dell’Ipertensione Arteriosa. 2023.
  5. Società Italiana di Medicina Generale. Trattamento farmacologico dell'ipertensione arteriosa. Rivista SIMG. 2020;1:8-15.