The need for combination antihypertensive therapy to reach target blood pressures: What has been learned from clinical practice and morbidity-mortality trials?

H. A J Struijker-Boudier, E. Ambrosioni, H. Holzgreve, S. Laurent, G. Mancia, L. M. Ruilope, B. Waeber

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Abstract

Pharmacological treatment of hypertension represents a cost-effective way for preventing cardiovascular and renal complications. To benefit maximally from antihypertensive treatment blood pressure (BP) should be brought to below 140/90 mmHg in every hypertensive patient, and even lower (<130/80 mmHg) if diabetes or renal disease co-exists. Most of the time such targets cannot be reached using monotherapies. This is especially true in patients who exhibit a high cardiovascular risk. The co-administration of two agents acting by different mechanisms considerably increases BP control. Such preparations are not only efficacious, but also well tolerated, and some fixed low-dose combinations have a tolerability profile similar to placebo. This is for instance the case for the preparation containing the angiotensin-converting enzyme inhibitor perindopril (2 mg) and the diuretic indapamide (0.625 mg), a fixed low-dose combination that has recently been shown in controlled interventional trials to be more effective than monotherapies in reducing albuminuria, regressing cardiac hypertrophy and improving macrovascular stiffness. Fixed-dose combinations are becoming more and more popular and are even proposed by current hypertension guidelines as a first-line option to treat hypertensive patients.

Original languageEnglish
Pages (from-to)1592-1602
Number of pages11
JournalInternational Journal of Clinical Practice
Volume61
Issue number9
DOIs
Publication statusPublished - Sep 2007

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ASJC Scopus subject areas

  • Medicine(all)

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