Evaluation of recent fixed-dose combination therapies in the management of hypertension.
OBJECTIVE
Control of hypertension remains sub-optimal with only half of patients achieving adequate control. The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines recommend initial use of two antihypertensive agents in patients with stage 2 hypertension. This review discusses the drug combinations that have additive effects and those that do not provide additional benefit while increasing the adverse events.


RESULTS
Results from late-breaking trials have shown that combinations of a calcium channel blocker and angiotensin-converting enzyme inhibitor are superior to a diuretic with an angiotensin-converting enzyme inhibitor for reducing cardiovascular events. Additionally, in patients with vascular disease with relatively 'controlled' blood pressure at baseline, the combination of an angiotensin-converting enzyme inhibitor and angiotensin receptor blocker did not reduce cardiovascular endpoints compared with either monotherapy and modestly increased the incidence of adverse effects.


CONCLUSIONS
Combination therapy of antihypertensive agents (e.g. angiotensin-converting enzyme inhibitor/calcium channel blocker, angiotensin-converting enzyme inhibitor/diuretics, and angiotensin receptor blocker/diuretics) as initial therapy in stage 2 hypertension can lead to markedly improved blood pressure control in patients compared with monotherapeutic regimens.
Khanna
Apurv
A
Division of Hypertension and Clinical Pharmacology, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut 06030-3940, USA. akhanna@uchc.edu
Lefkowitz
Lance
L
White
William B
WB
D000959:Antihypertensive Agents / Q000008:administration & dosage*; D002561:Cerebrovascular Disorders / Q000150:complications / Q000503:physiopathology; D048909:Diabetes Complications / Q000150:complications / Q000503:physiopathology; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D006331:Heart Diseases / Q000150:complications / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007674:Kidney Diseases / Q000150:complications / Q000503:physiopathology
D000959:Antihypertensive Agents; D004338:Drug Combinations