Evidence for improvement in survival with antihypertensive combination treatment

Hypertension constitutes a major risk factor for an array of cardiovascular diseases. Rates of morbidity and mortality related to its complications are high and remain an important concern in terms of public health. Improvement in cardiovascular outcomes and survival is an ultimate goal of the antihypertensive treatment. However, despite the wide range of available antihypertensive drugs, the rates of BP control are still insufficient. In most hypertensive patients, more than one antihypertensive compound is necessary to achieve goal levels of blood pressure. Assuming a greater antihypertensive effect may be obtained from two or more agents given in association, many combination therapies have been proposed and tested in a number of studies. The best clinical trial evidence comes from large outcome studies with an ACE inhibitor and dihydropyridine calcium antagonist combination, that of perindopril/amlodipine in the ASCOT trial in particular.