New trends in hypertension management: of salt, going solo and single pill combos

To critically examine the scientific basis of emerging concepts in the monitoring and treatment of hypertension.

Effective targeting of treatment strategies requires accurate assessment of blood pressure. Isolated use of manual office blood pressure measurement cannot detect white coat or masked hypertension. New information comparing automated office blood pressure (AOBP) to ambulatory blood pressure monitoring (ABPM) demonstrates that AOBP can minimize occurrence of white coat hypertension. From the public health perspective, reduction in salt consumption may be the single most important intervention, and could have a very significant impact on hypertension control. Further salt restriction strategies are effective means to decrease blood pressure even in patients with resistant hypertension. Provision of pharmacotherapy as single pill combinations is more effective than multiple drugs provided as monotherapy. From the hypertension practitioner perspective, complex choices are simplified, thus reducing therapeutic inertia. From the patient perspective, therapeutic turbulence is reduced and adherence to therapy increased. Combinations studied include thiazide diuretics with an inhibitor of the angiotensin system and the combination of amlodipine with angiotensin-converting enzyme (ACE) inhibitor. Amlodipine-based combinations are emerging as a valuable tool in the management of hypertension.

Progress in the monitoring of blood pressure, understanding of the public health benefits of more aggressive efforts to reduce dietary sodium intake and use of simplified algorithms featuring the use of low-dose single pill combinations will be expected to improve blood pressure control and reduce hypertension-related complications.