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Combination therapy in hypertension
Alan H Gradman1, Jan N Basile, Barry L Carter
1The Western Pennsylvania Hospital, Pittsburgh, Pennsylvania and Temple University School of Medicine, Philadelphia, PA, USA. gradmanmd@aol.com
Insights
Achieving blood pressure (BP) targets often requires combination therapy for hypertension. This position paper explores the scientific basis, drug choices, and patient selection for effective combination antihypertensive strategies.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Management
Background:
- Antihypertensive therapy aims to reduce cardiovascular (CV) risks from elevated blood pressure (BP) without compromising quality of life.
- BP reduction is the primary driver of CV risk reduction, with at least 75% of patients needing combination therapy to reach BP goals.
Purpose of the Study:
- To present a position paper on combination therapy for hypertension from the American Society of Hypertension.
- To address the scientific basis and pharmacologic rationale for specific antihypertensive drug combinations.
- To review patient selection criteria and discuss fixed-dose combinations and recent trial implications.
Main Methods:
- Review of scientific literature on combination antihypertensive therapy.
- Analysis of pharmacologic principles for selecting drug combinations.
- Evaluation of clinical trial data on specific combination strategies.
Main Results:
- BP reduction per se is the key determinant of CV risk reduction.
- Combination therapy is frequently required to achieve target BP levels in hypertensive patients.
- Fixed-dose combination pills offer practical advantages for consistent BP control.
Conclusions:
- Combination therapy is essential for effective hypertension management in a majority of patients.
- Strategic selection of drug combinations and patient criteria optimizes BP control and CV risk reduction.
- Further research and clinical practice emphasis are needed for consistent achievement and maintenance of goal BP.
Abstract:
The goal of antihypertensive therapy is to abolish the risks associated with blood pressure (BP) elevation without adversely affecting quality of life. Drug selection is based on efficacy in lowering BP and in reducing cardiovascular (CV) end points including stroke, myocardial infarction, and heart failure. Although the choice of initial drug therapy exerts some effect on long-term outcomes, it is evident that BP reduction per se is the primary determinant of CV risk reduction. Available data suggest that at least 75% of patients will require combination therapy to achieve contemporary BP targets, and increasing emphasis is being placed on the practical tasks involved in consistently achieving and maintaining goal BP in clinical practice. It is within this context that the American Society of Hypertension presents this Position Paper on Combination Therapy for Hypertension. It will address the scientific basis of combination therapy, present the pharmacologic rationale for choosing specific drug combinations, and review patient selection criteria for initial and secondary use. The advantages and disadvantages of single pill (fixed) drug combinations, and the implications of recent clinical trials involving specific combination strategies will also be discussed.
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