Key result
Combination therapy of antihypertensives as initial therapy in stage 2 hypertension improves blood pressure control compared with monotherapy.
Why the study?
Does combination antihypertensive therapy improve blood pressure control and reduce cardiovascular events in patients with hypertension compared to monotherapy or alternative combinations?
Does combination antihypertensive therapy improve blood pressure control and reduce cardiovascular events in patients with hypertension compared to monotherapy or alternative combinations?
Combination therapy as initial treatment in stage 2 hypertension markedly improves blood pressure control, with ACEi/CCB combinations showing superiority over ACEi/diuretic combinations for cardiovascular event reduction.
May guide initial dual therapy selection in stage 2 hypertension; extends guideline recommendations on additive combinations.
PURPOSE OF REVIEW: Control of hypertension remains sub-optimal with only half of patients achieving adequate control. The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines recommend initial use of two antihypertensive agents in patients with stage 2 hypertension. This review discusses the drug combinations that have additive effects and those that do not provide additional benefit while increasing the adverse events. RECENT FINDINGS: Results from late-breaking trials have shown that combinations of a calcium channel blocker and angiotensin-converting enzyme inhibitor are superior to a diuretic with an angiotensin-converting enzyme inhibitor for reducing cardiovascular events. Additionally, in patients with vascular disease with relatively 'controlled' blood pressure at baseline, the combination of an angiotensin-converting enzyme inhibitor and angiotensin receptor blocker did not reduce cardiovascular endpoints compared with either monotherapy and modestly increased the incidence of adverse effects. SUMMARY: Combination therapy of antihypertensive agents (e.g. angiotensin-converting enzyme inhibitor/calcium channel blocker, angiotensin-converting enzyme inhibitor/diuretics, and angiotensin receptor blocker/diuretics) as initial therapy in stage 2 hypertension can lead to markedly improved blood pressure control in patients compared with monotherapeutic regimens.
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Khanna et al. (2008) conducted a review in hypertension. Combination therapy of antihypertensive agents vs. monotherapy was evaluated. Combination therapy of antihypertensives as initial therapy in stage 2 hypertension improves blood pressure control compared with monotherapy.
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