Combination Therapy
Up to 75% of hypertensive patients will require dual or combination therapy to manage their BP.
Three or four agents may be needed to achieve targets in some patients.
If there is no significant reduction on monotherapy, the addition of second or third agents from different pharmacological classes at low doses is advised, rather than using high doses of the initial agent. “This approach maximises antihypertensive efficacy while minimising adverse effects.” Availability of combined single-tablet preparations are convenient to patients, saving them money in many cases, and can improve adherence.
NHF guidelines, basing recommendation on best available evidence, indicate that the most effective combination is an ACE inhibitor (or an angiotensin II receptor antagonist) plus a CCB. This regimen has a particular role especially in patients with diabetes or lipid abnormalities.
Australian Heart Foundation: www.heartfoundation.org.au
Australian Stroke Foundation: www.strokefoundation.org.au