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[Combination therapy for hypertension]

Anton H van den Meiracker1, A H J Jan Danser

  • 1Erasmus MC, afd. Inwendige Geneeskunde, Rotterdam.

Nederlands Tijdschrift Voor Geneeskunde
|October 10, 2013
PubMed

Insights

Antihypertensive monotherapy has limited blood pressure reduction. Combination therapy with multiple agents is often needed for effective hypertension management, especially using renin-angiotensin-system blockers with other drug classes.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacology

Background:

  • Antihypertensive monotherapy offers limited blood pressure reduction, with average systolic lowering of 9.1 mmHg and diastolic of 5.5 mmHg.
  • Approximately two-thirds of the hypertensive population require two or more antihypertensive agents for adequate control.

Purpose of the Study:

  • To review the rationale and strategies for initiating combination antihypertensive therapy.
  • To emphasize the importance of combination therapy for achieving blood pressure targets and improving patient compliance.

Main Methods:

  • Literature review on the efficacy and mechanisms of antihypertensive drug combinations.
  • Analysis of treatment initiation strategies, including stepwise versus immediate combination therapy.

Main Results:

  • Combination therapy, particularly with a renin-angiotensin-system (RAS) blocking agent and a RAS-independent agent, is recommended due to complementary mechanisms and proven efficacy.
  • Initial treatment may involve a stepwise approach or immediate initiation of two agents if blood pressure is significantly elevated (>20/10 mmHg).

Conclusions:

  • Combination antihypertensive therapy is essential for a majority of hypertensive patients.
  • Fixed-dose combination preparations are preferred to improve treatment compliance and adherence.

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