Monotherapy versus combination therapy as first line treatment of uncomplicated arterial hypertension

Mild to moderate hypertension still remains poorly controlled. This relates to multiple factors including low antihypertensive efficacy of single drug therapies. reluctance of primary care physicians to modify/titrate initial ly chosen therapy to obtain target blood pressure, and poor compliance with medication. Several guidelines for the treatment of high blood pressure no w include combination therapy with low doses of 2 drugs as one of the strat egies for the initial manage ment of mild/moderate arterial hypertension. E vidence discussed in this article points to superior control of blood press ure by combinations of low doses of 2 drugs as compared with monotherapy in regular doses. This superior effectiveness of combined therapy relates to a better antihypertensive efficacy and higher response rates in the low ran ge of doses as the result of complementary mechanisms of antihypertensive e ffects, better tolerance as a result of a lower rate of adverse effects in the low dose range, improved compliance from better tolerance and simple dr ug regimen, and lower cost. Whether increased use of fixed low dose combina tion therapies would translate to better control of arterial hypertension i n the population and thereby further reduction of cardiovascular/cerebrovas cular morbidity and mortality caused by hypertension remains to be assessed .