Apurv Khanna1, Lance Lefkowitz, William B White. 1. Division of Hypertension and Clinical Pharmacology, Pat and Jim Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut 06030-3940, USA. akhanna@uchc.edu
Abstract
PURPOSE OF REVIEW: Control of hypertension remains sub-optimal with only half of patients achieving adequate control. The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines recommend initial use of two antihypertensive agents in patients with stage 2 hypertension. This review discusses the drug combinations that have additive effects and those that do not provide additional benefit while increasing the adverse events. RECENT FINDINGS: Results from late-breaking trials have shown that combinations of a calcium channel blocker and angiotensin-converting enzyme inhibitor are superior to a diuretic with an angiotensin-converting enzyme inhibitor for reducing cardiovascular events. Additionally, in patients with vascular disease with relatively 'controlled' blood pressure at baseline, the combination of an angiotensin-converting enzyme inhibitor and angiotensin receptor blocker did not reduce cardiovascular endpoints compared with either monotherapy and modestly increased the incidence of adverse effects. SUMMARY: Combination therapy of antihypertensive agents (e.g. angiotensin-converting enzyme inhibitor/calcium channel blocker, angiotensin-converting enzyme inhibitor/diuretics, and angiotensin receptor blocker/diuretics) as initial therapy in stage 2 hypertension can lead to markedly improved blood pressure control in patients compared with monotherapeutic regimens.
PURPOSE OF REVIEW: Control of hypertension remains sub-optimal with only half of patients achieving adequate control. The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure guidelines recommend initial use of two antihypertensive agents in patients with stage 2 hypertension. This review discusses the drug combinations that have additive effects and those that do not provide additional benefit while increasing the adverse events. RECENT FINDINGS: Results from late-breaking trials have shown that combinations of a calcium channel blocker and angiotensin-converting enzyme inhibitor are superior to a diuretic with an angiotensin-converting enzyme inhibitor for reducing cardiovascular events. Additionally, in patients with vascular disease with relatively 'controlled' blood pressure at baseline, the combination of an angiotensin-converting enzyme inhibitor and angiotensin receptor blocker did not reduce cardiovascular endpoints compared with either monotherapy and modestly increased the incidence of adverse effects. SUMMARY: Combination therapy of antihypertensive agents (e.g. angiotensin-converting enzyme inhibitor/calcium channel blocker, angiotensin-converting enzyme inhibitor/diuretics, and angiotensin receptor blocker/diuretics) as initial therapy in stage 2 hypertension can lead to markedly improved blood pressure control in patients compared with monotherapeutic regimens.
Authors: Domenic Sica; George L Bakris; William B White; Michael A Weber; William C Cushman; Patrick Huang; Andrew Roberts; Stuart Kupfer Journal: J Clin Hypertens (Greenwich) Date: 2012-03-06 Impact factor: 3.738