Key Points
- To review evidence from clinical practice and morbidity-mortality trials on the necessity, efficacy, and tolerability of combination antihypertensive therapy versus monotherapy.
- Synthesized findings from interventional morbidity-mortality clinical trials and clinical practice observations addressing hypertension management.
- Evaluated target blood pressure attainment (<140/90 mmHg overall and <130/80 mmHg in diabetes or renal disease) using monotherapies compared to dual-agent regimens.
- Assessed outcomes of fixed low-dose combination therapy, specifically perindopril (2 mg) plus indapamide (0.625 mg), on vascular and end-organ markers.
- Monotherapy infrequently achieves goal blood pressures (<140/90 mmHg, or <130/80 mmHg in concurrent diabetes or renal disease), particularly in patients with elevated cardiovascular risk.
- Dual-agent regimens acting through complementary mechanisms substantially enhance blood pressure control while maintaining tolerability profiles comparable to placebo.
- Low-dose perindopril (2 mg) and indapamide (0.625 mg) fixed combination demonstrated superior efficacy over monotherapy in regressing cardiac hypertrophy, reducing albuminuria, and decreasing macrovascular stiffness.
Structured PICO
Does combination antihypertensive therapy improve blood pressure control and surrogate cardiovascular markers compared to monotherapy in hypertensive patients?
PPopulationHypertensive patients, including those with high cardiovascular risk, diabetes, or renal disease
IInterventionCombination antihypertensive therapy (e.g., fixed low-dose combination of perindopril 2 mg and indapamide 0.625 mg)
OOutcomeBlood pressure control (target < 140/90 mmHg, or < 130/80 mmHg with diabetes/renal disease)surrogate
Combination antihypertensive therapy, particularly fixed low-dose combinations, is highly effective and well-tolerated for achieving blood pressure targets and improving target organ damage compared to monotherapy.