Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Commentary
  • Published:

Antihypertensive drugs in combination: additive or greater than additive?

Journal of Human Hypertension volume 21, pages 914–916 (2007)Cite this article

In this edition of the Journal of Human Hypertension, Puig et al.1 report a study demonstrating that the calcium channel blocker (CCB) lercanidipine and the ACE inhibitor enalapril in combination have at least an additive effect on systolic blood pressure (BP) in elderly people with hypertension. Superficially, the findings are unremarkable, but concealed within the data is a message of considerable potential importance for the evaluation of antihypertensive drugs and the management of hypertension.

Despite a wealth of robust evidence that effective control of BP significantly reduces the morbidity and mortality associated with hypertension, control rates in many populations remain dismal.2, 3 Current national and international guidelines recommend rigorous BP targets in all treated individuals, with even more stringent goals in high-risk groups.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Puig JG, Calvo C, Luurila O, Luurila H, Sulosaari S, Strandberg A et al. Lercanidipine, enalapril and their combination in the treatment of elderly hypertensive patients: placebo controlled, randomised, crossover study with 4 ABPM. J Human Hypertens 2007; 21: 917–924 (this issue).

    Article  CAS  Google Scholar 

  2. Primatesta P, Poulter NR . Improvement in hypertension management in England: results from the Health Survey of England 2003. J Hypertens 2006; 24: 1187–1192.

    Article  CAS  Google Scholar 

  3. Wolf-Maier K, Cooper RS, Kramer H, Banegas JR, Giampaoli S, Joffres MR et al. Hypertension treatment and control in five European countries, Canada and the United States. Hypertension 2004; 43: 10–17.

    Article  CAS  Google Scholar 

  4. Chobanian AV, Bakris GE, Black HR, Cushman WC, Green LA, Izzo JL et al., The National High Blood Pressure Education Program Coordinating Committee. The seventh report of the joint national committee on prevention, detection, and treatment of high blood pressure. The JNC7 report. JAMA 2003; 289: 2560–2572.

    Article  CAS  Google Scholar 

  5. The task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC). Eur Heart J 2007; 28 (12): 1462–1536.

    Google Scholar 

  6. Williams B, Poulter NR, Brown MJ, Davis M, McInnes GT, Potter JF et al. Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004—BHS IV. J Hum Hypertens 2004; 18: 139–185.

    Article  CAS  Google Scholar 

  7. Materson BJ, Reda DJ, Cushman WC, Massie BM, Freis ED, Kochar MS et al. Single-drug therapy for hypertension in men: a comparison of six antihypertensive agents with placebo. The Department of Veterans Affairs Comparative Study Group on Antihypertensive Agents. N Engl J Med 1993; 328: 914–921.

    Article  CAS  Google Scholar 

  8. Lip GY, Barnett AH, Bradbury A, Cappuccio FP, Gill PS, Hughes E et al. Ethnicity and cardiovascular disease prevention in the United Kingdom: a practical approach to management. J Hum Hypertens 2007; 21 (3): 183–211.

    Article  CAS  Google Scholar 

  9. Deary AJ, Schumann AL, Murfet H, Haydock SF, Foo RS-Y, Brown MJ . Double-blind, placebo-controlled crossover comparison of five classes of antihypertensive drugs. J Hypertens 2000; 20: 771–777.

    Article  Google Scholar 

  10. ALLHAT Officers and co-ordinators. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to prevent Heart Attack Trial (ALLHAT). JAMA 2002; 288: 2981–2997.

    Article  Google Scholar 

  11. Law MR, Wald NJ, Morris JK, Jordan RE . Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials. BMJ 2003; 327: 1427–1435.

    Article  Google Scholar 

  12. Fagan TC . Remembering the lessons of basic pharmacology. Arch Intern Med 1994; 154: 1430–1431.

    Article  CAS  Google Scholar 

  13. Dickerson JEC, Hingorani AD, Ashby MJ, Palmer CR, Brown MJ . Optimisation of antihypertensive treatment by crossover rotation of four major classes. Lancet 1999; 353: 2008–2013.

    Article  CAS  Google Scholar 

  14. Marshall T . How many antihypertensives do patients need to achieve a target blood pressure? J Hum Hypertens 2005; 19: 317–319.

    Article  CAS  Google Scholar 

  15. Fogari R, Mugellini A, Zoppi A, Lazzari P, Destro M, Rinaldi A et al. Effect of telmisartan/hydrochlorothiazide vs lisinopril/hydrochlorothiazide combination on ambulatory blood pressure and cognitive function in elderly hypertensive patients. J Hum Hypertens 2006; 20 (3): 177–185.

    Article  CAS  Google Scholar 

  16. Rump LC, Ambrosioni E, Burnier M, Horl W, Rabelink AJ . Initial combination therapy with olmesartan/hydrochlorothiazide in moderate-to-severe hypertension. J Hum Hypertens 2006; 20 (4): 299–301.

    Article  CAS  Google Scholar 

  17. Ragot S, Sosner P, Yau C, Brunel P, Herpin D . Management in general practice of hypertensive patients poorly controlled with a fixed-dose renin–angiotensin system inhibitor and diuretic combination: results from a French national survey. J Hum Hypertens 2006; 20 (6): 407–418.

    Article  CAS  Google Scholar 

  18. Sica DA . Fixed-dose combination antihypertensive drugs. Do they have a role in rational therapy? Drugs 1994; 48: 16–24.

    Article  CAS  Google Scholar 

  19. Dahlõf B, Sever PS, Poulter NR, Wedel H, Beevers DG, Caulfield M et al., for the ASCOT investigators. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required, in the Anglo-Scandinavian Cardiac Outcomes Trial—Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet 2005; 366: 895–906.

    Article  Google Scholar 

  20. Brunner HR, Méndard J, Waeber B, Burnier M, Biollaz J, Nussberger J et al. Treating the individual patient: considerations of dose, sequential monotherapy and drug combinations. J Hypertens 1990; 8: 3–11.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiovascular and Medical Sciences, Western Infirmary, University of Glasgow, Glasgow, UK

    G T McInnes

Authors
  1. G T McInnes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G T McInnes.

Rights and permissions

Reprints and permissions

About this article

Cite this article

McInnes, G. Antihypertensive drugs in combination: additive or greater than additive?. J Hum Hypertens 21, 914–916 (2007). https://doi.org/10.1038/sj.jhh.1002272

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jhh.1002272

This article is cited by

Search

Advanced search

Quick links