Novel combinations in the treatment of hypertension

Not uncommonly the effective treatment of hypertension requires multi-drug therapy. Multi-drug combinations that dominate clinical practice typically include a thiazide-type diuretic together with either an angiotensin-converting enzyme inhibitor, or an angiotensin-receptor blocker, or a beta-blocker. On the other hand, there are several medication choices that provide incremental blood pressure reduction but all too often go under-appreciated as to their effectiveness. Such drug combinations include within class switching of diuretics, combining a thiazide-type diuretic with a calcium-channel blocker, utilizing 2 calcium-channel blockers from different classes, giving an ACE inhibitor together with an angiotensin-receptor blocker, adding an aldosterone receptor antagonist to any of several other drug classes, as well as adding nitrate therapy to any of several other drug classes. Such novel pharmacologic approaches offer useful options for treatment in the otherwise difficult to control hypertensive patient.