Hypertension: the rediscovery of combination therapy.

Awareness and treatment of hypertension in the United States has been improving for older patients, but hypertension continues in many cases to be poorly controlled. Three options exist if initial therapy fails to achieve target blood pressure: upward drug titration, substituting another drug, or combination drug therapy. Combination therapy is the attempt to optimize blood pressure control by using two or more agents with additive or synergistic effects. Problems with this approach include noncompliance due to complicated regimens, adverse drug reactions, and the added expense of multiple medications. However, the newer fixed-dose combination products have been shown to offer improved blood pressure control, simplification of drug regimens, decreased adverse reactions, improved compliance, and cost-effectiveness.