APPROACHES TO MEETING THE CRITERIA FOR FIXED-DOSE ANTIHYPERTENSIVE COMBINATIONS - FOCUS ON METOPROLOL

Fixed dose antihypertensive combinations are being used increasingly i n the management of hypertension. There are advantages and disadvantag es of this form of therapy. The key aims are to: (i) achieve increased efficacy by using drugs that complement each other's actions; (ii) us e low doses to minimise adverse effects; and (iii) provide a simple on ce daily regimen. Fixed dose combinations containing metoprolol have t he advantage that beta-blockers are drugs for which there is most evid ence that they are cardioprotective; metoprolol is the best documented beta-blocker in this context. The early combination of conventional r elease metoprolol and hydrochlorothiazide was inadequately investigate d by modern standards, but proved well tolerated and effective in clin ical practice. The introduction of the long acting metoprolol CR/ZOK ( controlled release/zero order kinetics) produced a very satisfactory o nce daily preparation with no major pharmacokinetic interactions. The fixed dose combination of felodipine and metoprolol CR/ZOK has been we ll investigated. The two agents complement each other's actions and to gether provide very effective blood pressure control, cardioprotection and very good tolerability. A case can be made that this preparation more closely meets the requirements of an ideal antihypertensive than a single agent given alone.