Fixed drug combinations in the treatment of hypertension: how to identify the optimal dose

RATIONALE FOR DRUG COMBINATIONS: The most common reason for combining different drugs is to achieve an additional fall in arterial pressure. It therefore seems reasonable to combine drugs with different mechanisms of actions. NEED FOR CLINICAL TRIALS: However, the effects of combination therapy on the heart and other target organs remains poorly documented. Most of what we know with regard to combination therapy on hypertensive heart disease is based on extrapolation from monotherapy. The fact that two drugs when used separately are beneficial in a disorder does not necessarily imply that their combination is equally or more beneficial in the same disorder. Thus, it will become important to establish efficacy and safety of new drug combinations on hypertensive target organs and on morbidity and mortality by performing carefully designed clinical trials.