EFFECTS OF COMBINATION THERAPY ON THE HEART

The presence of left ventricular hypertrophy (LVH) usually indicates t hat hypertension is moderately severe and that combination therapy wil l be required to control blood pressure (BP). Unfortunately, most stud ies on the reduction of LVH have been done with monotherapy, Our knowl edge of combination therapy in the treatment of hypertensive heart dis ease is to a great extent extrapolation from monotherapy. Angiotensin- converting enzyme (ACE) inhibitors in combination with calcium antagon ists ought to be particularly efficacious in reducing LVH. Drug classe s that either stimulate the renin angiotensin system or the sympatheti c nervous system are less likely to reduce LVH and should be avoided. In hypertensive patients with congestive heart failure, amlodipine sho uld be added to triple therapy with an ACE inhibitor, whereas in the p ost myocardial ischemia patient, verapamil may exert some additional b eneficial effects with regard to reinfarction rates. Of note, given th at two drugs when used separately are beneficial in a disorder does no t necessarily mean that their combination is equally or even move bene ficial. Thus, combination therapy should primarily be used for lowerin g arterial pressure and only secondarily to possibly improve concomita nt pathophysiologic conditions associated with hypertensive heart dise ase.