[Combination therapy for hypertension]

Abstract

The average systolic blood pressure-lowering effect of antihypertensive monotherapy is no more than 9.1 mmHg and for the diastolic value, 5.5 mmHg. Due to the limited effect of monotherapy, 2 or more antihypertensive agents are required in at least two-third of the hypertensive population. Because of their complementary blood pressure-lowering mechanisms and proven efficacy, it is advisable to initiate a combination of a renin-angiotensin-system (RAS) blocking agent with a RAS-independent agent; the choice of initial agents depends on age, ethnicity and co-morbidity. It is preferable that treatment is started using a stepwise approach: 1 agent is started and a second or third agent is added to the regimen. If the patient's actual blood pressure exceeds the target value by more than 20/10 mmHg, an alternative approach would be to start immediately with 2 agents. Compliance to therapy and the continuation of antihypertensive treatment are notoriously poor; treatment using a combination preparation containing 2 or even 3 different components is therefore preferred.