Combination Therapy in Hypertension

1. Front Matter

   Pages i-vii

   PDF

2. State of Hypertension Control

   • Joel Neutel

   Pages 1-11

3. Historical Review of Combination Therapy

   • Joel Neutel

   Pages 13-22

4. Advantages of Combination Therapy Compared with Monotherapy

   • Joel Neutel

   Pages 23-35

5. Use of Combination Therapy in Special Populations

   • Joel Neutel

   Pages 37-44

6. The Evidence Base for Combination Therapy

   • Joel Neutel

   Pages 45-70

7. Combination Therapy as First-Line Treatment

   • Joel Neutel

   Pages 71-77

8. Future Combination Agents

   • Joel Neutel

   Pages 79-80

9. Clinical Inertia in the Management of Hypertension

   • Joel Neutel

   Pages 81-84

For over 30 years, the stepped care approach has been used in the management and treatment of hypertension. This approach advocates the use of initial monotherapy to reach the desired blood pressure, and the subsequent use of additional drugs with complementary modes of action, until the target BP is achieved. However, current control rates for hypertension suggest that such an approach may be outdated and no longer effective in the management of hypertension. Clinical trials have shown that more than 50% of patients require a combination of drug therapies to achieve their target BP. Some proponents of combination therapy have argued that the risk of adverse side effects and non-compliance will be lower than that compared to monotherapy, which initially requires higher doses to be administered to be effective. Consequently, there have been increasing calls of the necessity for a much more combined approach in the treatment of hypertension. Adding to this, Combination Therapy in Hypertension will cover current control rates of blood pressure worldwide, the benefits of monotherapy and combination therapy, examine the effectiveness, risk of adverse effects, compliance, and cost of the available therapies and will also include information on relevant outcome studies.

• Combination Therapy
• Hypertension
• Polypharmacy
• blood pressure
• cardiovascular
• patients
• pharmacotherapy

• Department of Medicine, University of California in Irvine, Irvine, USA

  Joel M. Neutel

Dr. Neutel is an innovative and leading specialist in clinical hypertension. He is Medical Director of Clinical Pharmacology at Orange County Research Center, Director of Research at Memorial research Medical Clinic in Long Beach, and Staff Physician at Long Beach Memorial Medical Center and the Veterans Affairs Medical Center. He is also a founding partner of Integrium, a research organisation which focuses on clinical trials in cardiovascular and metabolic disease. A prominent advocate of the need for combination therapy in the management of hypertension, Dr. Neutel has researched and lectured extensively on the subject and has authored numerous abstracts, journal articles and book chapters. He has also been a reviewer and served on the editorial boards for a number of high profile journals. A prolific researcher, he has carried out extensive research in areas such as cardiovascular medicine, endocrinology, and central nervous system disorders.

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