Are two drugs better than one? A review of combination therapies for hypertension

ABSTRACT

Introduction: Current guidelines for pharmacotherapy briefly describe a role for combination antihypertensive therapy. However, guidance on whether combination therapy should be used at the time of initiating therapy or as add on, and the choice of combination therapy is scarce.

Areas covered: Current literature suggests that intensive blood pressure control is the key to managing cardiovascular risk. Along with lifestyle management, pharmacotherapy is an central component in the treatment of hypertension. Here, we aim to review the pathophysiology of hypertension, rationale for using combination therapy, and the different combinations of antihypertensive drug classes that are available in the market. Papers from 1967 through 2016 listed on PubMed on this topic were reviewed.

Expert opinion: Based on the review of the literature, combination antihypertensive therapies are more effective than monotherapy and are also well tolerated, safe and cost effective for treatment of hypertension. Further research is needed to help guide the choice of combination antihypertensive therapy in different patient populations based on age, gender, race and comorbidities.

KEYWORDS:

• Hypertension
• combination antihypertensive therapy
• antihypertensive drugs
• cardiovascular disease

Article highlights

• Current literature suggests that intensive blood pressure control is the key to managing cardiovascular risk.

• Guidance on whether combination therapy should be used at the time of initiating therapy or as add on, and the choice of combination therapy is scarce.

• Combination antihypertensive therapies are more effective than monotherapy and are also well tolerated, safe and cost effective for treatment of hypertension.

• The overall management of cardiovascular risk demands a holistic approach that targets hypertension, metabolic derangements such as diabetes and hyperlipidemia and other risk factors such as smoking.

• Pharmacotherapy with polypills that target multiple cardiovascular risk factors may be key to prevention.

• Cardiovascular polypills containing aspirin, statin, and one or more antihypertensive medications, along with lifestyle interventions, represent an attractive, safe, and cost-effective strategy for primary and secondary prevention of cardiovascular disease.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.