Combination therapy as first-line treatment of arterial hypertension

Mild to moderate hypertension still remains poorly controlled. This relates to multiple factors including low antihypertensive efficacy of single drug therapies, reluctance of primary care physicians to modify or titrate initially chosen therapy to obtain target blood pressure and poor compliance with medication. Evidence discussed in the present paper points to superior control of blood pressure by combinations of low doses of two drugs compared with monotherapy in regular doses. This superior effectiveness of combined therapy relates to a better antihypertensive efficacy and higher response rates in the low range of doses as the result of complementary mechanisms of antihypertensive effects. It is associated with better tolerance as the result of a lower rate of side effects in the low range of dosing, improved compliance from better tolerance and simple drug regimen, and lower cost. Increased use of fixed, low dose combination therapies can be expected to result in better control of arterial hypertension in the population. Given the evidence for superior antihypertensive efficacy and better tolerability, and the absence of harm from fixed, low dose drug combinations per se, this alternative deserves more consideration in the guidelines of major hypertension organizations.