Combination Of Antihypertensive Medications Research Articles

A Review on Bilayer Tablet Technology for Multi Modal Drug Delivery

Bilayer tablets are cutting-edge drug delivery technologies that enable the delivery of two medicines with various release patterns combined in a single unit. Bilayer tablets can deliver two incompatible medications in a single formulation, prolong the effect of the drug(s), and increase patient compliance. Bilayer tablets feature an active substance in one layer that is released immediately and another layer that is released later, either as a second dosage or in a prolonged release manner. The drawbacks of single-layered tablets are being overcome by the advancement of useful technology in bilayer tablets. Bilayer tablet technology requires a lot of resources, though. For each technical stage, a careful selection of excipients and manufacturing conditions is also necessary. High blood pressure patients frequently struggle or fail to control their BP with a single medication. To achieve treatment objectives, the majority of hypertension patients will require the use of two or more antihypertensive medications. When treating hypertension in patients whose blood pressure cannot be well controlled with monotherapy, combinations of antihypertensive medications from different categories have been demonstrated to be more successful than either medication alone. Combining two antihypertensive drugs with complementary modes of action may decrease blood pressure more effectively than using any one of these drugs by alone.
 Keywords: Bi-layer tablet, Tablet manufacturing, Bi-layer tableting techniques.

Study of Prescribing Pattern and Evaluation of the Efficacy of Monotherapy vs. Polytherapy Antihypertensive Drugs in Diabetes Patients

The monitoring pattern of antihypertensive drugs and evaluation of the efficacy of prescribed pharmacological regimen can provide important vision into control of hypertension and prevention of related comorbidities. This study aimed to evaluate prescribing patterns and efficacy of prescribed monotherapy vs. polytherapy antihypertensive drugs in diabetes patients. A hospital-based prospective study was conducted in the medicine department of Kempegowda Institute of Medical Sciences Hospital and Research Center, Bangalore, India for a duration of 12 months. A total of 720 hypertensive patients with type 2 diabetes mellitus aged = 18 years were included in this study. Ninety patients (31%) were presented with chronic kidney disease, followed by ischemic heart disease (82, 28.3%), stroke (78, 26.9%), and heart failure (40, 13.8%). Monotherapy was prescribed more commonly than polytherapy (60.14% vs. 39.86%). The majority of patients were treated with Calcium channel blockers. In both therapeutic regimens, mono- and polytherapy, amlodipine was found to be the most prescribed drug. Comparison between results of antihypertensive monotherapy and polytherapy regimens (a combination of different classes of antihypertensive drugs) revealed that only prescription of polytherapy was associated with a statistically significant reduction in both systolic and diastolic blood pressure (mean (SD) of systolic blood pressure before polytherapy vs. after polytherapy; 166 (3.2) vs. 139 (1.4), < 0.0001. mean (SD) of diastolic blood pressure before polytherapy vs. after polytherapy; 103 (1.6) vs. 88 (0.5), < 0.0001). Systolic/diastolic blood pressure was not controlled and maintained within a therapeutic goal among patients who received single antihypertensive medication (monotherapy). Therefore, a combination of antihypertensive medications needs to be considered to achieve controlled blood pressure and avoid clinical inertia among hypertensive patients with diabetes.Â

The efficacy of the combined antihypertensive and statin therapy in patients with hypertension and excessive body mass

Objective — to assess the effects of the of the combined therapy with fixed combinations of antihypertensive medications in combination with statin on the indices of systemic hemodynamics, lipid profile, carbohydrate metabolism and adipocytokines production in overweight patients with essential hypertension of II stage.Materials and methods. The investigation involved in-hospital 64 hypertensive (stage II) patients, the mean age 59.0 (48.0 — 63.0) years with excessive body mass (body mass index > 25 kg/m2), who were treated in the therapeutic department No. 1 of the medical and sanitary unit of JSC “Motor Sich” in the years 2016 — 2018. and met the study inclusion criteria. All patients underwent general clinical, laboratory and instrumental examination to verify the diagnosis, determine complications and comorbidities. The patients were randomized into two subgroups who were administered fixed combinations of antihypertensive drugs for 120 days. Patients of the first subgroup (n = 32) received a combined drug «Equator» («Gedeon Richter», Hungary) in an initial dose of 1 tablet (amlodipine — 5 mg and lisinopril — 10 mg) per day, patients of the second subgroup (n = 32) received Valodip (KRKA, Slovenia) in an initial dose of 1 tablet (amlodipine — 5 mg and valsartan — 80 mg) per day. Within 2 weeks, the dose of drugs was adjusted if necessary. All patients were administered Rosuvastatin (Roxera, KRKA) in a dose of 10 mg/day.Results. The change in the doses wasn’t required for 10 (31.3 %) patients from the first subgroup and 13 (40.6 %) from the second subgroup; for the rest of patients, the doses of drugs were increased as follows: Equator (amlodipine — 5 mg and lisinopril — 20 mg) 1 tablet per day and «Valodip» (amlodipine — 5 mg and valsartan — 160 mg) 1 tablet per day. The target blood pressure level (130/85 mm Hg) was achieved in 24 (75.0 %) patients in the first group and in 26 (81.3 %) in the second. During treatment in both subgroups, the following positive changes were observed: in systemic hemodynamic parameters there were normalization of systolic and diastolic blood pressure and improved cardiac pumping function; in lipid spectrum — the decreased levels of total cholesterol, low-density lipoprotein cholesterol against the background of an increase in high-density lipoprotein cholesterol. Moreover the carbohydrate metabolism improved (fasting blood glucose decreased) and adipocytes production normalized — the levels of proinflammatory cytokines (interleukin-1β (IL-1β) and tumor necrosis factor-α) decreased and anti-inflammatory IL-10, adiponectin increased.Conclusions. The reduced production of pro-inflammatory and increased production of anti-inflammatory cytokines and adiponectin against the background of normalization of the indices of systemic hemodynamics, the decrease of pro-atherogenic and raise in the antiatherogenic fraction of blood lipids, reduction of the glycemia level in the patients with hypertension and excessive body mass under the influence of the therapy with fixed combinations of antihypertensive drugs with the use of both angiotensin-converting inhibitors and sartans, with the addition of statins, showed the efficacy of such therapy and its capability to considerably reduce the cardiovascular risk in this category of patients.

Individualized Nursing Intervention: Its Effect on Enhancing Patients’ Adherence to Hypertensive Treatment Plan

Background: Hypertension is one of the leading causes of death or disability. Treatment plan of hypertension is a combination of antihypertensive medications, and adoption of healthy life style. Non-adherence to treatment plan is a growing concern to healthcare systems. Therefore, several researches were conducted to investigate factors that might lead to non-adherence to treatment plan as well effect of individualized nursing intervention to improve patients’ adherence to such treatment plan. Aim of the study: This study aimed to evaluate effect of individualized nursing intervention on enhancing patients’ adherence to hypertensive treatment plan. Method: A quasi experimental study design was used to conduct this study in medical wards in one of the governmental hospitals. A purposeful sampling technique was used according to inclusion and exclusion criteria. Eighty four patients participated in this study. Three tools were used for data collection as follows: First tool; patient's demographic data assessment tool. Second tool; self-administered questionnaire tool, to assess factors affecting patients’ adherence toward hypertensive treatment plan. Third tool; Hill-Bone Compliance to High Blood Pressure Therapy Scale, this tool was used twice before and after delivering individualized nursing intervention. Results: Revealed that, 57% of the studied sample their adherence were affected by some factors related to the medications, and nearly two third of them their adherence were affected by personal and financial factors. Also, the more increasing in age the more increasing non-adherence to treatment plan; this indicates that the factors affecting young age are different from those of the old age. Patient’s adherence toward hypertensive treatment plan significantly improved after delivering the individualized nursing intervention that copes with age related factors and all other individualized ones. Conclusion: The current study proved that individualized nursing intervention is significantly effective on enhancing patients’ adherence to hypertensive treatment plan through identifying and managing factors that hinder each patient to be adherent to the described treatment plan. Recommendation: In the light of the study results, the researchers recommended to conduct further studies that assess every age group separately as the factors and problems which hinder their adherence to hypertensive treatment plan among young age were completely different than those of the old age, as well to increase the number of the study sample to generalize the results, and to encourage nurses to follow the individualized care planning approach with their patients.

Designing Risk‐Adjusted Therapy for Patients with Hypertension

Limited guidance is available for providing patient‐specific care to hypertensive patients, although this chronic condition is the leading risk factor for cardiovascular diseases. To address this issue, we develop an analytical model that takes into account the most relevant risk factors including age, sex, blood pressure, diabetes status, smoking habits, and blood cholesterol. Using the Markov Decision Process framework, we develop a model to maximize expected quality‐adjusted life years, as well as characterize the optimal sequence and combination of antihypertensive medications. Assuming the physician uses the standard medication dose for each drug, and the patient fully adheres to the prescribed treatment regimen, we prove that optimal treatment policies exhibit a threshold structure. Our findings indicate that our recommended thresholds vary by age and other patient characteristics, for example (1) the optimal thresholds for all medication prescription are nonincreasing in age, and (2) the medications need to be prescribed at lower thresholds for males who smoke than for males who have diabetes. The improvements in quality‐adjusted life years associated with our model compare favorably with those obtained by following the British Hypertension Society's guideline, and the gains increase with the severity of risk factors. For instance, in both genders (although at different rates), diabetic patients gain more than non‐diabetic patients. Our sensitivity analysis results indicate that the optimal thresholds decrease if the medications have lower side‐effects and vice versa.

Antihypertensive medication adherence and associated factors among adult hypertensive patients at Jimma University Specialized Hospital, southwest Ethiopia

BackgroundAdherence to antihypertensive medications is a key component to control blood pressure levels. Poor adherence to these medications leads to the development of hypertensive complications and increase risk of cardiovascular events which in turn reduces the ultimate clinical outcome. The purpose of this study was to assess antihypertensive medication adherence and associated factors among adult hypertensive patients. A hospital-based cross-sectional study among adult hypertensive patients was conducted at hypertensive follow-up clinic of Jimma University Specialized Hospital from March 4, 2015 to April 3, 2015. A simple random sampling technique was used to select the study participants from the study population. The study patients were interviewed and their medical charts were reviewed using a pretested structured questionnaire. Adherence was assessed using Morisky Medication Adherence Scale-8 (MMAS-8) and MMAS-8 score less than 6 was considered as non-adherent and MMAS-8 score was ≥ 6 was declared as adherence. Factors associated with adherence were identified using binary and multivariate logistic regression analysis. Crude odds ratio, adjusted odds ratio (AOR) and 95% confidence interval of the odds ratio were calculated using SPSS version 21. Variables with p-value less than 0.05 were assumed as statistically significant factors.ResultsAmong 280 hypertensive patients, 61.8% of the study participants were found to be adherent. More than half (53.2%) of the participants were males and the mean age of the participants was 55.0 ± 12.7 years. Co-morbidity (AOR = 0.083, 95% CI = 0.033–0.207, p < 0.001), alcohol intake (AOR = 0.011, 95% CI = 0.002–0.079, p < 0.001), getting medications freely (AOR = 0.020, 95% CI = 0.003–0.117, p < 0.001), and combination of antihypertensive medications (AOR = 0.32, 95% CI = 0.144–0.712, p < 0.005) were inversely associated with antihypertensive medication adherence.ConclusionThe adherence level to the prescribed antihypertensive medications was found to be sub-optimal according to the MMAS-8, and influenced by co morbidity, alcohol intake, self-purchasing of the medications and combination of antihypertensive medications.

Hypertension prevalence, awareness, treatment, and control in northeast China: a population-based cross-sectional survey.

Hypertension has been recognized as a major risk factor for cardiovascular disease. We aimed to analyze the current prevalence, awareness, treatment, and control of hypertension in northeast China. This cross-sectional survey adopted the multistage stratified random cluster sampling method to obtain a representative sample of adults aged 40 years or older in the general population of northeast China. Hypertension was defined as a systolic blood pressure (SBP) ≥ 140 mm Hg, or diastolic blood pressure (DBP) ≥ 90 mm Hg, or self-reported use of antihypertensive medications in the last 2 weeks irrespective of BP. Altogether 4052 participants were included with weighted prevalence of hypertension of 57.3%. Among them, 47.4% were aware of their condition; 78.8% took antihypertensive medication, but only 10.2% had their blood pressure controlled. Individuals who were overweight/obesity, with dyslipidemia, or diabetes were at a higher risk of hypertension; these people also more likely to be aware of their condition. Subjects with a personal history of stroke were more inclined to receive antihypertensive medication, but that did not necessarily translate to well-controlled hypertension. Moreover, dyslipidemia (OR = 0.600; 95% CI: 0.375, 0.960) were associated with poor hypertension control. Subjects using combination of antihypertensive medications (OR = 2.924; 95% CI: 1.606, 5.325) or with a family history of coronary heart disease were more likely to have their blood pressure controlled. Our study identified a high prevalence of hypertension in northeast China. Although awareness and treatment rates improved over the last decade, the control rate remained disproportionately and unacceptably low.

Assessment of Prescribing Pattern of Antihypertensive Medications in Elderly Hypertensive

Introduction : In elderly hypertensive patients, blood pressure is over 140/90mmHg. Diuretics, renin angiotensin aldosterone system inhibitors, beta blockers, calcium channel blockers, alpha blockers and direct vasodilators are commonly prescribed to treat geriatric hypertensive patients. The choice of drugs for a particular patient changes at short intervals because of factors like changes in vascular compliance, efficacy, side effects, cost and launch of new drugs in pharmaceutical market. These facts indicate the need for assessment of prescribing pattern of antihypertensives. Objective: The prescribing pattern of antihypertensive medications was assessed in elderly patients who were suffering from hypertension. Methodology: It was a prospective observational study for six months carried out on in-patients who were admitted to general medicine units. The study protocol was approved by the human ethical committee. The patients of either sex and aged above 60 years and satisfying the study criteria such as diagnosed newly as suffering from hypertension as per Joint National Committee (JNC-7) guidelines and prescribed with antihypertensive medications were enrolled. The clinical, social and medication data was collected from the case records into a specialised patient profile form to analyze prescribing pattern of medications. All the data was analyzed using descriptive statistics. Results and Discussion: Totally 93 prescriptions were collected from the study patients. The proportion of male to female patients was 53:46 and their mean age was 68.74 ± 8.6years. Of 93 prescriptions, 50 (53.76%) prescriptions were containing antihypertensive medications as monotherapy and 43 (46.23%) prescriptions were containing antihypertensive medications as combination drug therapy. Of 50 prescriptions that were containing single antihypertensive medications, amlodepine was frequently 26 (52%) found prescribed among others. The results obtained in our study were similar to the study results conducted by Mohammed A et al. Among 43 prescriptions that were containing combination of antihypertensive medications, telmisartan+ hydrochlorothiazide were the drug combinations that were frequently 22 (51.16%) found prescribed among others.The results obtained in our study were similar to the study results conducted by Arshad HM et al. This combination was reported as fixed dose combinations used in hospitals in for treating patients enrolled in other studies. Conclusion: The medications such as amlodipine and telmisartanand hydrochlorothiazide are frequently prescribed as monotherapy and combination therapy respectievely to treat elderly patients suffering from hypertension.

EFFICACY AND SAFETY OF FIXED RAMIPRIL + FELODIPINE COMBINATION IN TREATMENT OF ARTERIAL HYPERTENSION: A RETROSPECTIVE STUDY-FORECAST

Approximately 30-50% of the world's adult population suffer from arterial hypertension, and only 30-35% is successfully treated. A large number of patients with arterial hypertension require a combination of antihypertensive medications to achieve target blood pressure. The ESH/ESC recommendations suggest the use of fixed dose combinations for treatment simplification and improved adherence to treatment. The aim of this study was to evaluate efficacy and safety of fixed ramipril + felodipine combination in therapy of essential arterial hypertension. This multicentric, cross-sectional, non-interventional study evaluated 1.341 adult patients with essential arterial hypertension, defined by systolic and diastolic blood pressure increase (BP≥140/90 mmHg), only systolic blood pressure increase or antihypertensive therapy usage. All patients were treated with fixed-dose combination therapy ramipril + felodipine (5+5mg and 2.5+2.5mg) (Triapin® and Triapin mite®) therapy for at least two months. Efficacy was evaluated by proportion of patients who achieved target blood pressure values (<140/90 mmHg and <130/80 mmHg in diabetics) or defined blood pressure reduction (≥15/10mmHg). Safety of ramipril + felodipine therapy was evaluated based on the incidence of adverse events (AE) and therapy discontinuation rate during observational period. Therapy prescription was based on physician decision according to everyday clinical practice and 15 consecutive eligible patients were enrolled by each physician from the cohort of hypertensive patients treated in ambulatory setting. Patient population consisted of 647 (48.4%) males and 690 (51.7%) females (mean age 60.15±11.84 and mean duration of hypertension 9.5±7.34 years). Males were significantly younger (58.74±15.5 vs. 61.45±11.04, p<0.01) without difference in body mass index. There were 47.5% of patients with stage II, 29.2% with stage I and 23.3% with stage III. There was a significant reduction of systolic/diastolic BP and heart rate in patients with ramipril + felodipine combination (162.6±17/97.2±9 mmHg and 79.4±12/min) compared to baseline values prior to treatment (136.9±17/84.2±9 mmHg and 73.2±10 /min, p<0.01). Group with Triapin mite had lower reduction of systolic/diastolic BP compared to Triapin 21.4±15.9/11.6±9.8 vs. 28.9±19.2/14.1±11.0 mmHg and lower reduction of heart rate 6.1 vs. 6.3 /min (p<0.01). In total, 39.3% of patients reached target BP with or without target BP reduction, 30.0% reached only BP reduction and 30.7% did not reach target values. More patients reached target BP (48.4 vs 32.%) and less achieved defined BP reduction (18.8 vs. 38.9%) on Triapin mite therapy compared to Triapin (p<0.01). The proportion of patients who failed to reach any of these endpoints is similar in both treatment modalities. AEs were present in 34 patients (2.5%): headache in 9 (0.7%), lower leg swelling in 8 (0.6%) and dry cough in 4 (0.2%) cases - these were reported as the most frequent. None of reported adverse events was serious. Therapy continuation was reported in 92.6% of patients. Reasons for therapy discontinuation were insufficient drug efficacy in 29 (2.2%) patients; AE in 28 (2.1%) patients and other reasons in 34 (2.6%) patients. Triapin therapy efficacy and safety evaluated by physicians were: excellent efficacy in 824 (61.4%) patients and excellent safety in 870 (64.9%) patients. Fixed dose combination of ramipril + felodipine was shown to be an effective antihypertensive therapy in patients with essential arterial hypertension and an alternative approach to monotherapy for the initial management of essential hypertension. Small proportion of patients discontinued from ramipril+felodipine therapy and rare AEs indicate excellent safety profile.

EFFECT OF GIVING ANTIHYPERTENSIVE DRUG AGAINST REDUCTION OF BLOOD PRESSURE IN ACUTE ISCHEMIC STROKE PATIENTS WHO HOSPITALIZED IN RSUP DR. SARDJITO YOGYAKARTA

Incidence of ischemic stroke 10 times more often than haemorrhagic stroke in the the west countries, but haemorrhagic stroke has a higher risk of mortality than ischemic stroke. One focus of acute stroke management is the management of hypertension. Blood pressure reduction in ischemic stroke patients could potentially reduce the risk of brain edema, the risk of hemorrhage, and prevent further vascular damage. However, an aggressive blood pressure reduction can cause a decrease in perfusion pressure to the ischemic area. Most hypertensive patients require two or more antihypertensive medications to achieve blood pressure targets. This study used observational study design with retrospective data collection on medical records of acute ischemic stroke patients and performed in RSUP Dr. Sardjito Yogyakarta period January 2010-December 2010. Data were analyzed with descriptive analysis and chi-square evaluative analysis on the relationship between the type of therapy with a reduction in blood pressure of acute ischemic stroke patients. Initial antihypertensive medication use in patients with acute ischemic stroke in RSUP Dr. Sardjito were 13 types of five classes of antihypertensive drugs. After getting a single antihypertensive medication, patients who experienced a decrease in systolic blood pressure on day-3 was 60%, while 17% fixed and 23% up and after getting a combination of antihypertensive medications, patients who experienced a decrease in systolic blood pressure on day-3 was 75%, while 10% fixed and 15% rise. Antihypertensive drug therapy alone or in combination had the same ability to lower systolic blood pressure (p = 0.260) and diastolic (p = 0.567) in patients with acute ischemic stroke in RSUP Dr. Sardjito Yogyakarta. Keywords : Hypertension, acute ischemic stroke, single antihypertensive drug, antihypertensive drug combinations, RSUP Dr.Sardjito Yogyakarta

The 2007 Canadian Hypertension Education Program recommendations: The scientific summary – an annual update

The present paper summarizes and highlights key messages of the 2007 Canadian Hypertension Education Program recommendations for the management and diagnosis of hypertension. This is the eighth annual update. Important new messages in the 2007 Canadian Hypertension Education Program recommendations emphasize the need for assessing adults with high normal blood pressure on an annual basis and reducing sodium in the diet of Canadians to less than 100 mmol/day. These new recommendations still need to be incorporated into the older but still important considerations for the diagnosis, management and treatment of patients with hypertension, namely, assessing blood pressure in all adults at all appropriate visits, expediting the diagnosis of hypertension, assessing and managing global cardiovascular risk, emphasizing that lifestyle modifications are the cornerstone of antihypertensive therapy, treating to target to achieve optimum cardiovascular risk reduction, using combinations of antihypertensive medications and lifestyle to achieve recommended targets and focusing on adherence to therapy. Minor changes in pharmacological therapies and some new recommendations on routine laboratory tests are discussed.

Highlights and summary of the 2006 Canadian Hypertension Education Program recommendations

The present paper summarizes and highlights key messages of the 2006 Canadian Hypertension Education Program recommendations for the management and diagnosis of hypertension. An important message in the 2006 Canadian Hypertension Education Program recommendations is to improve patient adherence to antihypertensive therapy by incorporating a number of techniques. These new recommendations still need to be incorporated into what remain as the older but still important considerations for the diagnosis, management and treatment of the patient with hypertension, namely, to assess blood pressure in all adults at all appropriate visits, to expedite the diagnosis of hypertension, to assess and manage global cardiovascular risk, to emphasize that lifestyle modifications are the cornerstone of antihypertensive therapy, to treat to target, and to use combinations of antihypertensive medications and lifestyles to achieve recommended targets. Minor changes in pharmacological therapies are discussed, and potentially important aspects related to home and self-monitoring, particularly with respect to patients with masked hypertension (blood pressure controlled in the office but not at home), are introduced.

Resistant hypertension and the Birmingham Hypertension Square.

Recent guidelines for the treatment of hypertension place great emphasis on tighter blood pressure control, especially in the presence of hypertensive target organ damage and diabetes. In order to achieve these treatment targets, more patients will require a combination of antihypertensive medications. However, resistant hypertension may have many possible underlying causes, and clinicians should appreciate how to detect and tackle these potential problems. Effective and synergistic combinations are therefore of vital importance, especially in patients with resistant hypertension. The choice of rational first- and second-line drugs that act in synergy could lead to better blood pressure management as well as significant financial savings for health care resources. The use of the Birmingham Hypertension Square for the optimum choice of add-in drugs for the treatment of resistant hypertension may aid management.

Evolution of Drugs That Preserve Renal Function

Over the past 50 years, many advances have been made in slowing the progression of renal disease from various causes. These advances have been primarily linked to defining new lower levels for blood pressure goals as well as understanding the importance of proteinuria reduction. To achieve these goals, it is also appreciated that agents that lower blood pressure must also lower proteinuria. This is not true for all antihypertensive drug classes--notably, direct-acting vasodilators, alpha-blockers, and dihydropyridine calcium antagonists. Interestingly, antihypertensive agents that also reduce proteinuria have been associated with cardiovascular risk reduction. Moreover, an understanding of combinations of antihypertensive medications that provide additive reductions in proteinuria may be even more efficacious for slowing renal disease progression. It is hoped that these advances and the projected advances in pharmacogenetics will reduce the current increasing incidence of people going on dialysis.

Combination drug therapy in hypertension: a rational approach for the pharmacist.

To review the use of combination therapy versus monotherapy in hypertension, and to review seven major antihypertensive combinations in regard to their pharmacologic actions and appropriateness. Literature was identified through a MEDLINE search from January 1985 to December 1997. Search terms included hypertension, blood pressure, combination therapy, diuretics, beta-receptor antagonists, calcium channel antagonists, angiotensin-converting enzyme inhibitors (ACEIs). Major hypertension texts were also reviewed for information on combination therapy. Clinical studies focusing primarily on blood pressure control with combinations of antihypertensive medications. Data were evaluated with respect to study design, clinical outcomes, and use of antihypertensive classes commonly seen in practice. Combination therapy in hypertension is often required because many patients cannot be controlled on one drug alone. Available data demonstrate that ACEIs plus diuretics or calcium channel blockers (CCBs) produce synergistic effects on blood pressure. Beta-blockers plus diuretics or CCBs produce additive effects, as does the rarer combination of diltiazem plus a dihydropyridine CCB. Ineffective combinations include beta-blockers plus ACEIs and dihydropyridine CCBs plus diuretics, although there are specific clinical circumstances where these combinations may be used. When used appropriately, certain combinations of antihypertensives can effectively control blood pressure and minimize side effects. The pharmacist who understands and applies the pharmacology of these antihypertensives can help prescribers make rational decisions in selecting combination therapy.