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Should Two-Drug Initial Therapy for Hypertension Be Recommended for All Patients?

  • Antihypertensive Agents: Mechanisms of Drug Action (HM Siragy and B Waeber, Section Editors)
  • Published:
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Abstract

Hypertension is a common disorder linked to increases in cardiovascular mortality and morbidity. Effective treatment decreases this excess mortality. Therapy with a single antihypertensive agent fails to achieve blood pressure goals in up to 75 % of patients. Compared to monotherapy, combination antihypertensive therapy, especially with fixed-dose (single pill) formulations, may more effectively control blood pressure and improve medication persistence while decreasing adverse effects, healthcare costs, and physician therapeutic inertia. Certain combinations, such as a calcium channel blocker and angiotensin converting enzyme inhibitor, have been associated with similar or fewer adverse effects and better outcomes than other combinations. In contrast, other combinations such as thiazide diuretics and β-blockers may cause more adverse effects than monotherapy. When choosing a thiazide diuretic, chlorthalidone is preferable to hydrochlorothiazide, given better efficacy and cardiovascular outcomes. Initial combination antihypertensive therapy may benefit patients with stage I or II hypertension and more widespread use should be encouraged.

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Disclosure

Dr. Cowart: none. Dr. Taylor serves as a board member for American Society of Hypertension and has received research funding from Novartis Pharmaceuticals, Forest Research Laboratories, National Institutes of Health (NIH), National Heart, Lung, and Blood Institute (NHLBI), National Institute of Neurological Disorders and Stroke (NINDS), and VPDiagnostics.

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  1. Division of Hypertension and Clinical Pharmacology, Baylor College of Medicine, 1709 Dryden Road, Suite 600, Houston, TX, 77030, USA

    Jennifer B. Cowart & Addison A. Taylor

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  1. Jennifer B. Cowart
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Correspondence to Addison A. Taylor.

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Cowart, J.B., Taylor, A.A. Should Two-Drug Initial Therapy for Hypertension Be Recommended for All Patients?. Curr Hypertens Rep 14, 324–332 (2012). https://doi.org/10.1007/s11906-012-0280-9

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