 Many comments have been issued about similarities and differences between 2003 American and European guidelines for the management of arterial hypertension 1,2, especially after the publication of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial ALLHAT study 3-5. Both guidelines agree that the majority of hypertensive patients require more than one medication to achieve optimal blood pressure control and, consistent with the most recent findings, the need of expensive, large clinical trials to demonstrate the superiority of one medication on another is probably over 3,6. What is clear now is that blood pressure must be optimally controlled to reduce risk of cardiovascular mortality and morbidity in population, no matter which combination of medications is used. Comparison between single medications is substantially academic and conceals the reality: in all trials, in most circumstances comparison is between combinations, more than single medications. In the Losartan Intervention for Endpoint Reduction Study LIFE study 6, for instance, there has been a comparison between the combination of losartan with low dose hydrochlorothiazide versus the combination of atenolol with the same diuretic. 