Individualization of Antihypertensive Drug Treatment

Antihypertensive drug classes areusually classified as 1st, 2nd, 3rd,and 4th or 5th choice to help physi-cians select the drug most suitable for treatment initiation among the very many classes available to lower blood pressure (BP) in patients with a BP elevation. However, this approach was appropriate decades ago when several drugs had inconveniences that made their use in monotherapy inadvisable. An example was the then widely used vasodilator hydralazine whose sodium-retaining and tachycardic effects made its administra-tion recommendable only with a diuretic or a b-blocker, with, thus, a classification as a 2nd- or 3rd-choice drug (1). This is no longer the case because several current antihypertensive drug classes are charac-terized by a similar BP-lowering effect (2), a good tolerability profile (2), and ev-idence of cardiovascular protection in prospective randomized trials (3,4). As recently argued in a document of the Eu-ropean Society of Hypertension (5), this implies that rather than classifying drugs