Who should be treated with combination therapy as initial treatment for hypertension?

There is currently consensus regarding the need to initiate antihypertensive therapy with a combination of two agents from different antihypertensive classes in selected patients. This consensus extends to the need to bring blood pressure to the appropriate level but has not been defined regarding optimal strategies for selection of combinations that may be most effective at reducing the morbidity and mortality associated with hypertension. Because of the heterogeneous nature of hypertension, there may be unique population-specific strategies for selecting antihypertensive regimens. Appropriate combinations of antihypertensive agents are particularly relevant for patients with diabetes, renal disease, and isolated systolic hypertension as well as for African Americans with high-risk hypertension. The antihypertensive regimen for high-risk patients should be based on those agents for which the patient has compelling indications, with the addition of agents deemed most likely to bring the patient to the appropriate blood pressure goal as quickly as possible.