Combination drug treatment of hypertension: have we come full circle?

Only 30% of hypertensive patients achieved and maintained adequate blood pressure control on a single drug in recent clinical trials. For the majority of patients who require two or more drugs to lower blood pressure to the currently recommended goals of 140/90 mm Hg or to 130/80 if they are diabetic or have chronic kidney disease, combinations of two or more drugs in a single pill offers an attractive alternative to taking multiple single drugs each day. Research has shown that the simpler the drug regimen the more likely patients are to be compliant in taking medications. Because a reduction in cardiovascular risk is linked to the extent to which elevated blood pressure is reduced, this benefit is not realized by patients who either discontinue their medications or are noncompliant. Carefully selected low doses of two antihypertensive drugs combined in a single pill offers other advantages including greater efficacy compared with high-dose monotherapy, a lower incidence of adverse effects, improved persistence in taking medications, fewer patient visits, and reduced cost to the health care system.