Antihypertensive Combination Therapy: Optimizing Blood Pressure Control and Cardiovascular Risk Reduction

Abstract

Treating hypertension reduces the rates of myocardial infarction, stroke, and renal disease; however, clinical trial experience suggests that monotherapy is not likely to be successful for achieving goal blood pressure (BP) levels in many hypertensive patients. In multiple recent clinical trials including various subsets of hypertensive patients, the achievement of BP goal has typically required the combination of 2 or more medications, particularly in patients with BP levels>160/100 mm Hg. When initiating combination therapy for hypertension, careful consideration must be given to the choice of medication. Clinical trial evidence has shown the efficacy of various combinations of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, and diuretics in reducing BP and cardiovascular risk. Ongoing trials should provide additional guidance on the optimal choice of combination regimens in specific clinical settings.

A study of fluid intake from beverages in a sample of healthy French children, adolescents and adults

“…In response to these physiological events, the body releases three hormones (namely antidiuretic hormone, angiotensin and aldosterone), in an attempt to try and maintain the blood supply to the brain and other essential organs. It is interesting to note that antihypertensive medication is currently prescribed against these very same hormones (Deedwania, 2007;Nesbitt, 2007). In 2002, a meeting was organized in Dortmund to study the physiological effects of mild dehydration, yet the majority of presentations showed the benefits of increased consumption of fluid, be it at the level of cognition (Wilson and Morley, 2003), exercise performance (Maughan, 2003), urolithiasis Beverage intake in the French F Bellisle et al (Siener and Hesse, 2003), urinary tract infection (Beetz, 2003), dental disease (Smith and Shaw, 2003), constipation (Arnaud, 2003) or even broncho-pulmonary infection (Kalhoff, 2003).…”

Role of combination therapy in the treatment of hypertension: Focus on valsartan plus amlodipine

“…11,12 Fixed combination therapies are particularly able to significantly increase patient compliance and longterm stay on-treatment, reduce side effects and (when appropriately chosen) allow the achievement of lower SBP and DBP levels. 13 …”

ARBs and ACEis together in the treatment of hypertension and its complications? current practical recommendations

“…Combined ACEi and ARB therapy has been shown to play a positive role in patients with proteinuric nephropathies and congestive heart failure (CHF) with incomplete neurohormonal blockade (patients without beta-blockers or who cannot tolerate the required dosage of an ACEi), particularly in young patients (Figure 2) [14]. However, the additive effect of the dual blockade on BP control has been shown to be less than that attained by either drug combined with a diuretic or a calcium channel blocker [15]. The data from the Article highlights.…”