FIXED-DOSE COMBINATIONS OF ACE-INHIBITORS

First-line antihypertensive monotherapy is effective in reducing blood pressure to within the normal range in approximately 50% of patients, Normalisation in the remaining patients may require a combination of two or more drugs, This review considers the clinical efficacy and tol erability of combinations involving angiotensin-converting enzyme (ACE ) inhibitors. The efficacy of combinations with diuretics or calcium a ntagonists, as initial therapy or in patients with inadequate response s to monotherapy, has been demonstrated in many trials, With combinati on therapy, normalisation rates approaching 80% can be achieved using submaximal doses of both components. Therapy with both combinations is well tolerated; with ACE inhibitors reducing the diuretic metabolic e ffects or counteracting some calcium antagonist-associated vasodilator y effects. Data on ACE inhibitors with beta-blockers are limited, When patients respond inadequately to first-line monotherapy, the increasi ng availability of drug combinations will allow individual selection o f the most appropriate combination, taking account of additional risk factors and concomitant disease.