Valsartan combination therapy in the management of hypertension – patient perspectives and clinical utility

Abstract

The morbidity and mortality benefits of lowering blood pressure (BP) in hypertensive patients are well established, with most individuals requiring multiple agents to achieve BP control. Considering the important role of the renin-angiotensin-aldosterone system (RAAS) in the pathophysiology of hypertension, a key component of combination therapy should include a RAAS inhibitor. Angiotensin receptor blockers (ARBs) lower BP, reduce cardiovascular risk, provide organ protection, and are among the best tolerated class of antihypertensive therapy. In this article, we discuss two ARB combinations (valsartan/hydrochlorothiazide [HCTZ] and amlodipine/valsartan), both of which are indicated for the treatment of hypertension in patients not adequately controlled on monotherapy and as initial therapy in patients likely to need multiple drugs to achieve BP goals. Randomized, double-blind studies that have assessed the antihypertensive efficacy and safety of these combinations in the first-line treatment of hypertensive patients are reviewed. Both valsartan/HCTZ and amlodipine/valsartan effectively lower BP and are well tolerated in a broad range of patients with hypertension, including difficult-to-treat populations such as those with severe BP elevations, prediabetes and diabetes, patients with the cardiometabolic syndrome, and individuals who are obese, elderly, or black. Also discussed herein are patient-focused perspectives related to the use of valsartan/HCTZ and amlodipine/valsartan, and the rationale for use of single-pill combinations as one approach to enhance patient compliance with antihypertensive therapy.

Keywords:

• amlodipine
• combination therapy
• hydrochlorothiazide
• hypertension
• valsartan

Acknowledgments and disclosures

The preparation of this manuscript was made possible by funding from Novartis Pharmaceuticals Corporation. Dr Nash and Michael S McNamara (medical writer) drafted the manuscript. Dr Nash reviewed the first draft and revised it critically for important intellectual content. Editorial support for styling of the manuscript and creation of tables and figures was provided by Simon Lancaster. Rita Samuel, Medical Director at Novartis Pharmaceuticals Corporation, USA, checked the scientific accuracy of the data reported from several valsartan studies. Dr Nash received support from Novartis Pharmaceuticals Corporation for the preparation of this manuscript.