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.

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