Role of valsartan, amlodipine and hydrochlorothiazide fixed combination in blood pressure control: an update

Abstract

The treatment of moderate or severe hypertension in most cases requires the contemporaneous use of multiple antihypertensive agents. The most available two-drug combinations have an agent that addresses renin secretion and another one that is statistically more effective in renin-independent hypertension. The practice of combining agents that counteract different mechanisms is the most likely explanation for the fact that most available two-drug combinations have an agent that addresses renin secretion (beta-blocker, angiotensin converting enzyme inhibitor, angiotensin II receptor blocker or direct renin inhibitor) and another one that is more effective in renin-independent hypertension (diuretic, dihydropyridine or non-dihydropyridine calcium channel blocker). Based on these considerations, addition of hydrochlorothiazide to the combination of an antagonist of the renin-angiotensin system with a calcium channel blocker would constitute a logical approach. Inclusion of a diuretic in the triple combination is based on the evidence that these agents are effective and cheap, enhance the effect of other antihypertensive agents, and add a specific effect to individuals with salt-sensitivity of blood pressure. The benefit of triple combination therapy with amlodipine, valsartan and hydrochlorothiazide over its dual component therapies has been demonstrated, and the use of a single pill will simplify therapy resulting in better blood pressure control.

Keywords: HCTZ; amlodipine; blood pressure; hydrochlorothiazide; hypertension; valsartan.

Figure 1

CCB–ARB: synergy of counter-regulation. Abbreviations: ARB, angiotensin receptor blocker; BP, blood presssure; CCB, calcium channel blocker; CHF, congestive heart failure; RAS, renin-angiotensin system.

Figure 2

Mechanism of action of valsartan. Abbreviations: ACE, angiotensin converting enzyme; AT₁, angiotensin II type 1; AT₂, angiotensin II type 2.

Figure 3

Efficacy of amlodipine/valsartan compared with amlodipine monotherapy in patients with grade 2 + 3 hypertension: Study design. Abbreviations: Amlo, amlodipine; Val, valsartan; HCTZ, hydrochlorothiazide; wks, weeks.