Expanding Role for Combination Drug Therapy in the Initial Treatment of Hypertension?

Abstract

See related article, pp 566–572 Both the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and the European Society of Hypertension have recommended initiating antihypertensive therapy with a single agent in patients with stage 1 or grade 1 hypertension (systolic 1 agent is recommended for patients with blood pressure >20/10 mm Hg above goal1 or for patients with grade 2 or grade 3 hypertension (systolic ≥160 mm Hg and/or diastolic ≥100 mm Hg) or high overall cardiovascular risk where early blood pressure control may be desirable.2 However, based in part on data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial, ≈75% of patients with hypertension will require therapy with >1 antihypertensive agent to achieve recommended blood pressure goals. Based on analyses of large numbers of published clinical trials, overall, it has been estimated that the blood pressure–lowering capacities of low doses of 2 agents used in combination are additive3 or that the average percentage effects of the second …