title: Blood pressure control with angiotensin receptor blocker-based three-drug combinations: key trials.
abstract: BACKGROUND
  Most hypertensive patients only achieve blood pressure (BP) control with a combination of antihypertensive drugs from different classes and many require three or more drugs. Two three-drug, fixed-dose combinations are available: (1) the angiotensin receptor blocker (ARB), valsartan (VAL), the calcium channel blocker, amlodipine (AML), and the diuretic, hydrochlorothiazide (HCTZ); (2) the ARB, olmesartan medoxomil (OLM), AML, and HCTZ.
  
  
  METHODS
  This article reviews two clinical studies in patients with moderate-to-severe hypertension, which compared the efficacy and safety of VAL/AML/HCTZ and OLM/AML/HCTZ with the component two-drug combinations.
  
  
  RESULTS
  Each triple combination produced significantly greater reductions in seated systolic/diastolic BP and higher BP control rates than the two-drug combinations. Subgroup analyses showed that BP reductions and control rates with the three-drug combinations were unaffected by age, gender, race, and hypertension severity (VAL/AML/HCTZ and OLM/AML/HCTZ), and that efficacy was maintained for up to 52 weeks (OLM/AML/HCTZ). OLM/AML/HCTZ and VAL/AML/HCTZ also produced significantly larger reductions in ambulatory systolic and diastolic BP over 24 hours, the daytime, and nighttime compared with two-drug combinations. Adverse events were mainly of mild or moderate intensity and each threedrug combination was well tolerated.
  
  
  CONCLUSIONS
  ARB/AML/HCTZ combinations produce BP reductions and control rates superior to two-drug combinations and may help difficult-to-treat patients to achieve BP control.
authors.affiliation: Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Plaza Dr. Robert, 5, 08221, Terrassa, Spain. adelasierra@mutuaterrassa.es
authors.forename: Alejandro
authors.initials: A
authors.lastname: de la Sierra
authors.forename: Vivencio
authors.initials: V
authors.lastname: Barrios
mesh_terms: D017311:Amlodipine / Q000627:therapeutic use; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004338:Drug Combinations; D006801:Humans; D006852:Hydrochlorothiazide / Q000627:therapeutic use; D006973:Hypertension / Q000188:drug therapy*; D007093:Imidazoles / Q000627:therapeutic use; D000068557:Olmesartan Medoxomil; D016032:Randomized Controlled Trials as Topic; D013777:Tetrazoles / Q000627:therapeutic use; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000068756:Valsartan
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics; D004338:Drug Combinations; D007093:Imidazoles; D013777:Tetrazoles; D006852:Hydrochlorothiazide; D017311:Amlodipine; D000068557:Olmesartan Medoxomil; D000068756:Valsartan; D014633:Valine