title: Strategies for combination therapy in hypertension.
abstract: OBJECTIVE
  To achieve the target blood pressure (BP) mandated by current guidelines, a large majority of patients require simultaneous administration of multiple antihypertensive agents. The purpose of this review is to focus attention on the rational selection of effective drug combinations, and upon ways to use them efficiently to achieve therapeutic objectives. The topic is widely relevant given that more than 46  million ambulatory care visits are conducted in the United States annually for hypertension management.
  
  
  RESULTS
  Recommended drug combinations exhibit complimentary pharmacology and additive BP reduction, are well tolerated, and include components with demonstrated endpoint reduction in long-term clinical trials. Recently, the choice of diuretics has emerged as a controversial issue with some evidence favoring the long-acting agent, chlorthalidone, in preference to hydrochlorothiazide. For resistant hypertension, mineralocorticoid antagonists are increasingly used as preferred add-on agents. Practical strategies for the optimal use of combination therapy continue to evolve from the older stepped-care approach to the use of low-dose combinations, and to initiation of combination therapy in a broader range of hypertensive patients.
  
  
  CONCLUSIONS
  Thoughtful use of drug combinations is critical for achieving therapeutic objectives in hypertensive individuals and populations - more rapid BP control and more effective endpoint reduction. Practical strategies for the optimal use of combination therapy continue to evolve from the older stepped-care approach to more recent recommendations favoring the use of low-dose combinations, and initiation therapy of combination treatment, particularly in patients with Stage 2 hypertension.
authors.affiliation: Temple University School of Medicine (Clinical Campus), Pittsburgh, Pennsylvania 15232, USA. gradmana@temple.edu
authors.forename: Alan H
authors.initials: AH
authors.lastname: Gradman
mesh_terms: D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents