Combination therapy in the treatment of hypertension: Addressing the clinical issues

A. Zanchetti

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While many randomised trials have firmly established the benefits of lowering blood pressure in hypertension, including mild hypertension, the extent by which elevated blood pressure should be lowered has not been properly explored. Consequently, investigators in most trials have been content to lower diastolic blood pressure by only a few mmHg. Despite this limited goal in most trials of antihypertensive therapy, more than 50% of treated patients have had to receive more than one antihypertensive agent in combination. Furthermore, many of the original trials of antihypertensive therapy used large doses of the initial compound, which was usually a diuretic. These doses are now recognised to have been too large and to have been, at least in part, responsible for the adverse subjective and metabolic effects reported in these trials. Mounting evidence for the benefits of a greater reduction in blood pressure (awaiting confirmation from the ongoing Hypertension Optimal Treatment [HOT] study) and concern for the adverse effects of excessive doses of any antihypertensive compound are increasing interest in the use of combination therapy in hypertension. This attitude is reflected in the 1993 WHO/ISH guidelines which state: 'In order to achieve the full goal of antihypertensive treatment in all hypertensive patients, not nfrequently two-drug and sometimes three-drug combinations may be required'. Among drug combinations (in addition to the traditional association of a diuretic with either a beta-blocker or an ACE inhibitor) attention has recently been concentrated on the association of an ACE inhibitor with a calcium antagonist. Finally, the WHO/ISH guidelines also recognise that 'for reasons of convenience, cost and increased patient compliance, preparations that combine two drugs in a single tablet or capsule may be appropriate for many hypertensive patients'.

Original languageEnglish
Pages (from-to)44-51
Number of pages8
JournalInternational Journal of Clinical Practice, Supplement
Issue number90
Publication statusPublished - Jun 1997

ASJC Scopus subject areas

  • Medicine(all)


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