The treatment of hypertension comprises numerous pharmacological options, which may hinder patient management standardization, thus contributing to therapeutic failure. However, in more recent years, several studies and guidelines from diverse hypertension and cardiology societies have suggested preferential pharmacological classes to treat hypertension. – Based on this evidence, the present report aims to propose a simple and practical pharmacological treatment algorithm that can be applied to patients ranging from stage 1 to refractory hypertension cases ( ).
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Pharmacological Treatment of Hypertension: From the Golden Trio to the Octet
FeitosaADM, Mota-GomesM, Passarelli JúniorO, BarrosoWKS, MirandaRD, BarbosaECD, BrandãoAA, et al. Pharmacological Treatment of Hypertension: From the Golden Trio to the Octet. Arq. Bras. Cardiol. 2020;115(2):270-2.
Feitosa,Audes Diógenes Magalhães; Mota-Gomes,Marco; Passarelli Júnior,Oswaldo; Barroso,Weimar Kunz Sebba; Miranda,Roberto Dischinger; Barbosa,Eduardo Costa Duarte; Brandão,Andrea A.; Nadruz,Wilson. Pharmacological Treatment of Hypertension: From the Golden Trio to the Octet. Arq. Bras. Cardiol., v. 115, n. 2, p. 270-272, Aug. 2020.
Feitosa,A.D.M., Mota-Gomes,M., Passarelli Júnior,O., Barroso,W.K.S., Miranda,R.D., Barbosa,E.C.D., Brandão,A.A., & Nadruz,W. (2020). Pharmacological Treatment of Hypertension: From the Golden Trio to the Octet. Arq. Bras. Cardiol.,115(2), 270-272.
Feitosa,Audes Diógenes Magalhães and Mota-Gomes,Marco and Passarelli Júnior,Oswaldo and Barroso,Weimar Kunz Sebba and Miranda,Roberto Dischinger and Barbosa,Eduardo Costa Duarte and Brandão,Andrea A. and Nadruz,Wilson. Pharmacological Treatment of Hypertension: From the Golden Trio to the Octet. Arq. Bras. Cardiol. [online]. 2020, vol. 115, n. 2, [cited 2025-09-06], pp.270-272. Available from: <https://abccardiol.org/en/article/pharmacological-treatment-of-hypertension-from-the-golden-trio-to-the-octet/>. ISSN 0066-782X.
Figure 1
– Structured octet for the treatment of hypertension.THIAZ: thiazide-type/thiazide-like diuretic; RASI: renin angiotensin system inhibitor; CCB: calcium-channel blocker; βB: Beta-blocker; α2A: central alpha-2 agonist; α1B: alpha-1 adrenergic blocker; VD: direct vasodilator. *When BP control is not achieved with THIAZ, RASI and CCB, and the THIAZ is hydrochlorothiazide, substitute this latter drug by a long-acting THIAZ (chlortalidone or indapamide). If glomerular filtration rate <30 mL/min, substitute THIAZ by a loop diuretic, such as furosemide. †If spironolactone is not tolerated, particularly due to anti-androgenic side effects, consider substituting this drug by amiloride. ‡βB is indicated as the first choice for the initial treatment when there are specific indications, such as angina, post-myocardial infarction, heart failure, arrhythmia or heart rate control.