Initial treatment strategies for high blood pressure: position statements from scientific societies in Paraguay

Abstract

Introduction: High blood pressure is the leading preventable cause of cardiovascular disease and premature death worldwide. In Paraguay, it affects more than 38.6% of the adult population, with suboptimal control rates despite the availability of multiple therapies.

Objective: To issue an institutional position based on available evidence supporting the use of combination therapy as an initial strategy in the pharmacological treatment of high blood pressure in Paraguay.

Methods: A multidisciplinary group of experts was formed. International guidelines (ESC/ESH, ACC/AHA, ISH, LASH) and national and regional epidemiological data were reviewed. The modified Delphi technique was applied to reach consensus on the recommendations.

Results: The evidence shows that initial combination therapy, especially in fixed-dose formulations, improves blood pressure control, reduces cardiovascular events, and promotes therapeutic adherence. Specific subgroups were identified in which monotherapy may be considered.

Conclusion: The various national scientific societies recommend the use of drug combinations from the outset in most patients with high blood pressure, promoting their implementation as a national clinical standard.