Combination therapy in hypertension: an Asia-Pacific consensus viewpoint

Abstract

Hypertension incurs a significant healthcare burden in Asia-Pacific countries, which have suboptimal rates of blood pressure (BP) treatment and control. A consensus meeting of hypertension experts from the Asia-Pacific region convened in Hanoi, Vietnam, in April 2013. The principal objectives were to discuss the growing problem of hypertension in the Asia-Pacific region, and to develop consensus recommendations to promote standards of care across the region. A particular focus was recommendations for combination therapy, since it is known that most patients with hypertension will require two or more antihypertensive drugs to achieve BP control, and also that combinations of drugs with complementary mechanisms of action achieve BP targets more effectively than monotherapy. The expert panel reviewed guidelines for hypertension management from the USA and Europe, as well as individual Asia-Pacific countries, and devised a treatment matrix/guide, in which they propose the preferred combination therapy regimens for patients with hypertension, both with and without compelling indications. This report summarizes key recommendations from the group, including recommended antihypertensive combinations for specific patient populations. These strategies generally entail initiating therapy with free drug combinations, starting with the lowest available dosage, followed by treatment with single-pill combinations once the BP target has been achieved. A single reference for the whole Asia-Pacific region may contribute to increased consistency of treatment and greater proportions of patients achieving BP control, and hence reducing hypertension-related morbidity and mortality.

Keywords: :

• Antihypertensive combination therapy
• Asia-Pacific consensus
• Fixed-dose combinations
• Guidelines
• Hypertension

Transparency

Declaration of funding

The Asia-Pacific Cardiology Advisory Board was supported by an unrestricted educational grant from Merck Pte Ltd.

Declaration of financial/other relationships

A.R.A.R. has disclosed that he is on the Speakers’ Bureau of Merck Serono, MSD, Servier, Menarini, and Sanofi. He has also received an honorarium from Takeda for participating in an advisory panel. E.B.R. has disclosed that he has received sponsorship from AstraZeneca, Servier, and Natrapharm; has received research grants from AstraZeneca; is a consultant to Merck Serono, AstraZeneca, Servier, and Innogen, and is on the Speakers’ Bureau of Servier. P.S., A.P., and P.V.D. have disclosed that they are consultants to Merck Serono. B.T. has disclosed that he has received sponsorship from Merck Serono, and has received research grants from Abbott, AstraZeneca, BMS, GSK, Merck Serono, MSD, Novartis, Roche and Takeda. He is a consultant to Amgen, AstraZeneca, Janssen, Merck Serono and MSD, and is on the Speakers’ Bureau of Merck Serono and MSD.

CMRO peer reviewer 1 has disclosed that he has been a consultant to MSD, and is on the Speakers’ Bureau of MSD and Genzyme. CMRO peer reviewer 2 has no relevant financial or other relationships to disclose.

Acknowledgments

Kelvin Lim, MIMS Pte Ltd, provided writing assistance and editorial support, which was funded by Merck Pte Ltd.