title: Newer renin-angiotensin-aldosterone system blocker combinations: is there an advantage?
abstract: OBJECTIVE
  The necessity for new and more effective management approaches to achieve blood pressure goals is still present in spite of the number of antihypertensive medications available. One of the cornerstones of successful therapy is implementation of drug combinations that act on complementary biological pathways. This review article focuses on the evaluation of recent data supporting newer combinations involving inhibition of the renin-angiotensin-aldosterone system (RAAS) with other drug classes such as calcium channel blockers (CCBs) and diuretics.
  
  
  RESULTS
  New angiotensin receptor blockers as well as renin inhibitors, with a more robust blood pressure-lowering effect than their predecessors, have emerged recently. The data presented in this text also strongly supports a combination therapy approach as initial therapy to achieve blood pressure goals in a timely fashion. Additionally, the blood pressure-lowering effect is more robust with lower-dose, single-pill combinations than with highest doses of single agents alone. Therefore, using combination agents is less prone to side effects. The challenges for such single-pill combinations remain affordability. For this reason, payers and patients have traditionally not preferred such agents in spite of better blood pressure control and adherence rates.
  
  
  CONCLUSIONS
  The new combinations of renin inhibitors and the new angiotensin receptor blocker combinations add to the armamentarium of agents to control blood pressure. Whereas the new angiotensin receptor blocker offers greater efficacy on blood pressure control over other agents in the class and the availability of the only chlorthalidone combination, no outcome data exist yet with any of the new agents.
authors.affiliation: Hypertensive Diseases Unit, University of Chicago, Pritzker School of Medicine, Chicago, Illinois 60637, USA.
authors.forename: Ivana
authors.initials: I
authors.lastname: Lazich
authors.forename: George L
authors.initials: GL
authors.lastname: Bakris
mesh_terms: D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004338:Drug Combinations; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D012084:Renin-Angiotensin System / Q000187:drug effects*; D016896:Treatment Outcome; D000092502:Renin Inhibitors
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics; D004338:Drug Combinations; D000092502:Renin Inhibitors