Combination versus Monotherapy as Initial Treatment in Hypertension

Monotherapy is able to normalize blood pressure in less than a quarter of patients with hypertension. However, for a disease of multifactorial pathogenesis like essential hypertension, a therapeutic strategy employing different principles of actions is most suitable. In addition, combination therapy has many advantages. Blood pressure reduction is improved by an additive effect and through neutralization of compensatory counter-regulatory reactions. The number and severity of adverse effects are reduced by lower dose requirements. Some clinical trials have documented blood pressure-independent, i. e., true synergistic, organ-protective effects. Furthermore, combination therapy is expected to reduce costs and to improve therapeutic compliance. In a clinical trial, initial low-dose combination therapy has been shown to be superior as compared to treatment by the stepped-care and the sequential monotherapy approach. Recently, therefore, low-dose combination therapy has been recommended for initial antihypertensive therapy instead of the stepped-care approach or of sequential monotherapy.