title: Initial combination therapy for rapid and effective control of moderate and severe hypertension.
abstract: Moderate (grade 2) and severe (grade 3) hypertension are important public health problems associated with high cardiovascular risk. Blood pressure (BP) control becomes more difficult to achieve as hypertension progresses. Therefore, early and effective treatment is essential to prevent hypertensive urgencies and emergencies and reduce cardiovascular risk. Currently, less than 50% of patients being treated for moderate or severe hypertension in the United States achieve their BP goal as recommended by treatment guidelines. This review examines the cardiovascular risk and physician inertia associated with moderate and severe hypertension, and concludes that increased use of initial combination therapy can overcome many of the barriers to effective BP control. Furthermore, initial combination therapy with a renin-angiotensin system (RAS) inhibitor and diuretic has the potential to rapidly and effectively reduce BP across a range of baseline BPs, with a comparable adverse event profile to monotherapy.
authors.affiliation: Department of Medicine, Medical Sciences I, College of Medicine, University of California, Irvine, CA 92697, USA. ssfranklinmd@earthlink.net
authors.forename: S S
authors.initials: SS
authors.lastname: Franklin
authors.forename: J M
authors.initials: JM
authors.lastname: Neutel
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D004232:Diuretics / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D017408:Guidelines as Topic; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D012720:Severity of Illness Index
chemical_list: D000959:Antihypertensive Agents; D004232:Diuretics