The need for combination antihypertensive therapy to reach target blood pressures: what has been learned from clinical practice and morbidity-mortality trials?
Pharmacological treatment of hypertension represents a cost-effective way for preventing cardiovascular and renal complications. To benefit maximally from antihypertensive treatment blood pressure (BP) should be brought to below 140/90 mmHg in every hypertensive patient, and even lower (< 130/80 mmHg) if diabetes or renal disease co-exists. Most of the time such targets cannot be reached using monotherapies. This is especially true in patients who exhibit a high cardiovascular risk. The co-administration of two agents acting by different mechanisms considerably increases BP control. Such preparations are not only efficacious, but also well tolerated, and some fixed low-dose combinations have a tolerability profile similar to placebo. This is for instance the case for the preparation containing the angiotensin-converting enzyme inhibitor perindopril (2 mg) and the diuretic indapamide (0.625 mg), a fixed low-dose combination that has recently been shown in controlled interventional trials to be more effective than monotherapies in reducing albuminuria, regressing cardiac hypertrophy and improving macrovascular stiffness. Fixed-dose combinations are becoming more and more popular and are even proposed by current hypertension guidelines as a first-line option to treat hypertensive patients.
Department of Pharmacology and Toxicology, University of Maastricht, MD Maastricht, The Netherlands. h.struijkerboudier@farmaco.unimaas.nl
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Struijker-Boudier
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Ambrosioni
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Holzgreve
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Laurent
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Mancia
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Ruilope
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Waeber
D000959:Antihypertensive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001794:Blood Pressure; D002986:Clinical Trials as Topic; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007190:Indapamide / Q000008:administration & dosage / Q000009:adverse effects; D020913:Perindopril / Q000008:administration & dosage / Q000009:adverse effects
D000959:Antihypertensive Agents; D004338:Drug Combinations; D007190:Indapamide; D020913:Perindopril