Rationale for the use of a fixed combination in the treatment of hypertension

There are two major reasons responsible for the increasing popularity of the combination of two or more antihypertensive drugs as a common approach to hypertension treatment. Firstly there is evidence that this allows achievement of satisfactory blood pressure control when monotherapy is partially ineffective, thereby improving patient compliance with the therapeutic regimen and enhancing the tolerance/effectiveness ratio of the treatment. The second reason relates to the fact that combination treatment allows treatment efficacy to be extended to a much larger fraction of the hypertensive population than would be achievable with monotherapy. This paper briefly reviews the theoretical background of and the practical requirements for effective combination treatment. It also discusses the priority two-drug combinations recommended by the recent WHO-ISH guidelines on the treatment of hypertension. Finally it examines the advantages and limitations of the combination treatment aimed at simplifying antihypertensive therapy and thus improving patient compliance.