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Are fixed-dose combination antihypertensives suitable as first-line therapy?
Sverre E Kjeldsen1, Franz H Messerli, Chern-En Chiang
1Oslo University Hospital, Ullevaal, Oslo, Norway. s.e.kjeldsen@medisin.uio.no
Current Medical Research and Opinion
|September 18, 2012
Summary
Fixed-dose combinations (FDC) for hypertension offer improved blood pressure control and patient compliance. Early use of FDC as initial therapy can help bridge the gap in achieving blood pressure targets.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Blood pressure control remains suboptimal despite increased antihypertensive use.
- Cardiovascular risk may be amplified in Asian populations due to blood pressure disparities.
- International guidelines increasingly recommend early combination therapy for hypertension management.
Purpose of the Study:
- To evaluate the role of fixed-dose combinations (FDC) in initial antihypertensive therapy.
- To compare FDC with monotherapy and loose-dose combinations for hypertension management.
- To inform clinical practice regarding the incorporation of FDC into treatment guidelines.
Main Methods:
- Non-systematic literature search of PubMed (2007-2012) for randomized controlled trials.
- Focused search on calcium channel blocker (CCB)-renin angiotensin system (RAS) blocker combinations.
- Inclusion of relevant literature and consultation of international hypertension treatment guidelines.
Main Results:
- A significant gap exists between antihypertensive use and achieved blood pressure control.
- CCB-RAS blocker FDC demonstrate benefits in compliance, blood pressure lowering, and safety.
- Simplified guidelines and FDC use are associated with improved blood pressure control.
Conclusions:
- Physicians should reconsider current antihypertensive treatment approaches.
- Earlier adoption of antihypertensive FDC, including as first-line therapy, can improve blood pressure target achievement.
- FDC offer superior compliance compared to loose-dose combinations and are suitable for widespread use.
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