Combination therapy in hypertension: An update

Abstract

Meticulous control of blood pressure is required in patients with hypertension to produce the maximum reduction in clinical cardiovascular end points, especially in patients with comorbidities like diabetes mellitus where more aggressive blood pressure lowering might be beneficial. Recent clinical trials suggest that the approach of using monotherapy for the control of hypertension is not likely to be successful in most patients. Combination therapy may be theoretically favored by the fact that multiple factors contribute to hypertension, and achieving control of blood pressure with single agent acting through one particular mechanism may not be possible. Regimens can either be fixed dose combinations or drugs added sequentially one after other. Combining the drugs makes them available in a convenient dosing format, lower the dose of individual component, thus, reducing the side effects and improving compliance. Classes of antihypertensive agents which have been commonly used are angiotensin receptor blockers, thiazide diuretics, beta and alpha blockers, calcium antagonists and angiotensin-converting enzyme inhibitors. Thiazide diuretics and calcium channel blockers are effective, as well as combinations that include renin-angiotensin-aldosterone system blockers, in reducing BP. The majority of currently available fixed-dose combinations are diuretic-based. Combinations may be individualized according to the presence of comorbidities like diabetes mellitus, chronic renal failure, heart failure, thyroid disorders and for special population groups like elderly and pregnant females.

Polypharmacy Treatment of Hypertensionin Public Health Centers

“…In a previous study, in ACE inhibitors with CCBs Cardiovascular Events Trial in patients with hypertension and diabetes, it was found that those receiving this combination were approximately 50% less likely to experience a major cardiovascular event. 7 However, a study conducted in Canada shows that the primary combination includes an ACE inhibitor and diuretic (78%), followed by an ARB and diuretic (16%), and an ACE inhibitor and CCB (6%). 4 About 67% of respondents were given a combination of 3 drugs which comprises of ACE inhibitor, CCB and diuretics.…”

Drug utilization pattern of antihypertensive agents in patients of hypertensive nephropathy in a tertiary care hospital: a cross sectional study

“…Mostly combination therapy was used in our study when compared with the monotherapy which was in accordance with earlier studies. 6,7 Combinations of anti-hypertensive drugs with complementary actions may minimize adverse effects and reduce clinical outcomes by improving BP control and organ protection. 7 Most commonly a combination of 3 drugs was prescribed and amidst various drugs prescribed a CCB (Amlodipine) was the most commonly prescribed drug as it is recommended in older age group and also for chronic use.The most common drug prescribed is comparable to study done by Datta S et al and Almas A et al, although few studies have also shown differing results.…”

“…6,7 Combinations of anti-hypertensive drugs with complementary actions may minimize adverse effects and reduce clinical outcomes by improving BP control and organ protection. 7 Most commonly a combination of 3 drugs was prescribed and amidst various drugs prescribed a CCB (Amlodipine) was the most commonly prescribed drug as it is recommended in older age group and also for chronic use.The most common drug prescribed is comparable to study done by Datta S et al and Almas A et al, although few studies have also shown differing results. [8][9][10][11] We also found that 70% of the drugs were prescribed from Essential drug list 2011 implying that there was no drug procurement problem and though only 16.67% patients were prescribed generic drugs but still these should be prescribed more often so that the patients can get the options of choosing drug according to his economic conditions.…”

Study of the effect of formulation variables on the characteristics of combination tablets containing enalapril maleate and indapamide as active substances using experimental design

“…It has been established that lowering of blood pressure can effectively reduce the risk of cardiovascular events and stroke, but finding the most appropriate therapy is often difficult (1). Combinational therapies employing an angiotensin-converting enzyme inhibitor (ACEi) and indapamide (IND) offer the advantage of using two highly effective agents, increasing both clinical efficiency and patient compliance (2)(3)(4). Low dose combinations of ACEis and diuretics have shown greater reduction in blood pressure and higher success rates in managing hypertension than either of the treatments alone (4)(5)(6).…”

“…Combinational therapies employing an angiotensin-converting enzyme inhibitor (ACEi) and indapamide (IND) offer the advantage of using two highly effective agents, increasing both clinical efficiency and patient compliance (2)(3)(4). Low dose combinations of ACEis and diuretics have shown greater reduction in blood pressure and higher success rates in managing hypertension than either of the treatments alone (4)(5)(6). The most popular ACEis present in these combinations include perin-dopril (2) and delapril (7), but the effectiveness of enalapril maleate (ENA) in combination with IND was also established (8).…”