title: Role of valsartan, amlodipine and hydrochlorothiazide fixed combination in blood pressure control: an update.
abstract: The treatment of moderate or severe hypertension in most cases requires the contemporaneous use of multiple antihypertensive agents. The most available two-drug combinations have an agent that addresses renin secretion and another one that is statistically more effective in renin-independent hypertension. The practice of combining agents that counteract different mechanisms is the most likely explanation for the fact that most available two-drug combinations have an agent that addresses renin secretion (beta-blocker, angiotensin converting enzyme inhibitor, angiotensin II receptor blocker or direct renin inhibitor) and another one that is more effective in renin-independent hypertension (diuretic, dihydropyridine or non-dihydropyridine calcium channel blocker). Based on these considerations, addition of hydrochlorothiazide to the combination of an antagonist of the renin-angiotensin system with a calcium channel blocker would constitute a logical approach. Inclusion of a diuretic in the triple combination is based on the evidence that these agents are effective and cheap, enhance the effect of other antihypertensive agents, and add a specific effect to individuals with salt-sensitivity of blood pressure. The benefit of triple combination therapy with amlodipine, valsartan and hydrochlorothiazide over its dual component therapies has been demonstrated, and the use of a single pill will simplify therapy resulting in better blood pressure control.
authors.affiliation: Internal Medicine, Ospedale Unificato Broni-Stradella, Stradella (PV), Italy. maurizio_destro@ospedali.pavia.it
authors.forename: Maurizio
authors.initials: M
authors.lastname: Destro
authors.forename: Francesca
authors.initials: F
authors.lastname: Cagnoni
authors.forename: Antonio
authors.initials: A
authors.lastname: D'Ospina
authors.forename: Alessandra Rossi
authors.initials: AR
authors.lastname: Ricci
authors.forename: Elena
authors.initials: E
authors.lastname: Demichele
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Peros
authors.forename: Augusto
authors.initials: A
authors.lastname: Zaninelli
authors.forename: Paola
authors.initials: P
authors.lastname: Preti
mesh_terms: D017311:Amlodipine / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004359:Drug Therapy, Combination / Q000379:methods; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use*; D006973:Hypertension / Q000188:drug therapy*; D013777:Tetrazoles / Q000627:therapeutic use*; D014633:Valine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000068756:Valsartan
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D013777:Tetrazoles; D006852:Hydrochlorothiazide; D017311:Amlodipine; D000068756:Valsartan; D014633:Valine
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