Maximizing blood pressure lowering effects: a review of drug class comparisons and rationale for combination...

Numerous studies have reported on the antihypertensive effects of pharmacological treatments, primarily focusing on efficacy comparisons between drug classes, blood pressure (BP)-lowering responses in specific populations, or pleiotropic effects beyond BP reduction. However, the magnitude of BP reduction across agents varies. Additionally, the synergistic effects of combination therapies, and the potential existence of dose-response relationships remain significant clinical dilemmas for physicians. Emerging evidence suggests that many cardiovascular drugs exhibit incidental BP-lowering properties, though further validation is required. Given the critical role of BP management in cardiovascular care coupled with pharmacological heterogeneity and interpatient variability, clinicians face challenges in optimizing targeted treatment strategies for maximal therapeutic benefit. This review synthesizes current evidence on: (1) Drug-class-specific BP-lowering profiles, (2) Dose-dependent efficacy, and (3) Combination therapy strategies. The goal is to provide outcome-driven guidance for clinical decision-making in hypertension management.