THE ROLE OF COMBINATION THERAPY IN THE TREATMENT OF HYPERTENSION

Only approximately 40% to 50% of hypertensive patients will achieve go al blood pressures of <140/90 mm Hg with monotherapy, regardless of th e medication used. Fixed-dose combination therapy with two different c lasses of antihypertensive agents will achieve goal pressures in more than 70%. The sixth Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure has suggested that the use of co mbination therapy is appropriate as initial treatment. The advantages of combinations include: 1) greater blood pressure decrease and respon se rates than monotherapy; 2) fewer side effects with small doses of t wo drugs than with large doses of one agent; 3) improved adherence to treatment; and 4) possibly lower cost of therapy. Many different combi nations of diuretics and beta-blockers, angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor antagonists, as well as A CE inhibitors and calcium antagonists are available. Two of these, Zia c and Capozide, have been approved as initial therapy. It is possible that the number of hypertensive individuals controlled at goal blood p ressure levels will be increased if combination therapy is used as ini tial treatment. (C) 1998 American Journal of Hypertension, Ltd.