[Combination therapy versus monotherapy: which strategy is better?]

In patients without target organ damage, a pharmacological antihypertensive therapy can be initiated with a monotherapy or a low dose combination therapy. A monotherapy often suffices to control blood pressure in patients with mild hypertension (140-159 mmHg systolic or 90-99 mmHg diastolic). In order to select the blood pressure-lowering drug that is best suited for an individual, monotherapies should be sequentially rotated, because it cannot be predicted to which drug a patient will best respond. Early initiation of a combination therapy is a good alternative. Theoretically, almost any of the six commonly used groups of antihypertensive drugs (ACE-Inihibitors, Angiotensin II-Receptor Antagonists, Beta-blockers, Calcium antagonists, Diuretics and Alpha blockers) can be combined with each other. However, combinations of Thiazid diuretics with inhibitors of the Renin-Angiotensin-Aldosteron-System (Beta blockers, ACE-Inhibitors, Angiotensin II-Receptor blockers) have proven most useful.