Drug classes and scientific evidence for their clinical outcomes:

The main classes of drugs with scientific evidence for reducing cardiovascular incidents through lowering blood pressure include:

ACE inhibitors: Angiotensin-converting enzyme inhibitors.

ARBs: Angiotensin receptor blockers.

CCBs: Calcium channel blockers of the dihydropyridine type.

Diuretics: Such as thiazide, thiazide-like drugs like hydrochlorothiazide, chlorthalidone, and indapamide.

Beta-blockers.

The first four classes are considered primary treatment options. However, beta-blockers are added in specific cases where they play a pivotal role, such as in managing angina, heart failure, post-myocardial infarction, and rapid heart rhythms. In these cases, second-generation cardioselective beta-blockers, or particularly third-generation vasodilating beta-blockers, are preferred. Nevertheless, beta-blockers are less effective than ACE inhibitors, ARBs, CCBs, or diuretics in preventing strokes and are associated with higher withdrawal rates due to side effects. Combining beta-blockers and diuretics is not recommended as it increases the risk of diabetes in susceptible patients.

Drug combinations and dose escalation strategies:

Combination therapy: Preferred for reducing blood pressure due to its ability to target multiple physiological pathways contributing to hypertension for each patient. Additionally, it allows for the use of lower doses of each agent, potentially reducing side effects and improving adherence to long-term therapy.

Low-dose combination therapy: Recommended initially for individuals with hypertension. It provides benefits such as fewer side effects and quicker control of blood pressure, enhancing long-term adherence. Combination drugs in a single preparation are preferable.

Patients with elevated blood pressure (120–139 mmHg systolic/70–89 mmHg diastolic) but who are not hypertensive, are treated with monotherapy.

For most hypertensive patients, a single pill containing two of the primary four drug classes is recommended at a low starting dose. Triple therapy with renin-angiotensin system modulators, calcium channel blockers, and diuretics is the best tolerated. If this fails to provide adequate control, the patient is considered treatment-resistant, and spironolactone or eplerenone (or another renin-angiotensin system modulator) is added.

Beta-blockers can be added as an alternative to aldosterone receptor antagonists as a fourth-line therapy.

Subsequently, central blood pressure-lowering agents, alpha-blockers, hydralazine, or potassium-sparing diuretics may be considered.

Combining two renin-angiotensin system inhibitors, such as an ACE inhibitor and an ARB, is not recommended.

To access the full recommendations, please refer to the provided link:

https://www.portailvasculaire.fr/sites/default/files/docs/ehae178.pdf

Finally, we present several drug combinations produced by Oubari Pharma that align with these recommendations:

Fixed-Dose Combinations:

• Losartic
• Cansartic
• Valsartan Oubari HCT
• Valsartan Oubari MAX
• Valsartan Amlodipine Oubari

And single-agent therapies:

• Amlodipine Oubari
• Bisolol
• Cansartan
• Valsartan Oubari

Practical algorithm for pharmacological blood pressure lowering: