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The Rationale of Use of Combination Therapy in Hypertensive Patients
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The goal of antihypertensive therapy is to abolish the risks associated with blood pressure (BP) elevation without adversely affecting quality of life. Control of hypertension and treatment of concomitant pathophysiologic conditions require use of multiple drugs. Unfortunately, most studies regarding hypertensive disease have focused on monotherapy. Available data suggest that at least 75% of patients will require combination therapy to achieve contemporary BP targets, and increasing emphasis is being placed on the practical tasks involved in consistently achieving and maintaining goal BP in clinical practice. Thus, our knowledge of combination therapy in the treatment of hypertension is to a great extent extrapolation from monotherapy. Drug selection is based on efficacy in lowering BP and in reducing cardiovascular (CV) end points including stroke, myocardial infarction, and heart failure. Although the choice of initial drug therapy exerts some effect on long-term outcomes, it is evident that BP reduction per se is the primary determinant of CV risk reduction. This combination therapy presents the pharmacologic rationale for choosing specific drug combinations, and review patient selection criteria for initial and secondary use. Angiotensin-converting enzyme (ACE) inhibitors and calcium antagonists combinations should be particularly efficacious in reducing hypertensive target organ disease. Both of these drug classes have been shown to reduce hypertensive heart disease, diminish microproteinuria, and the decline in renal function. With regard to hypertensive vascular disease, both ACE inhibitors and calcium antagonists have documented benefits.
Keywords
ACE Inhibitors, Calcium Antagonists (calcium Channel Blocker), Left Ventricular Hypertrophy, Hypertension, Congestive Heart Failure, Combination Therapy, Drug Therapy, Angiotensin Receptor Blocker, Beta Blockers and Diuretic
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