Combination therapy in hypertension

There is controversy as to which BP-lowering manoeuvres and/or drugs can be combined effectively. Ideally, a combination therapy should show an additional BP-lowering effect over monotherapy. The effect should be of sufficient clinical significance, without short- or long-term adverse effects, and the patients should feel well. Combination therapy should be based on the understanding of the mechanisms of action of the different classes of drugs used and of their interaction. Rational combinations include an ACE inhibitor or a beta-blocker together with moderate salt restriction or a thiazide diuretic or a calcium antagonist. Less rational combinations include an ACE inhibitor with a beta-blocker, and a calcium antagonist with a thiazide diuretic.