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Hypertension

Combination therapy for hypertension

Two or more drugs are needed to control blood pressure in the majority of patients with hypertension. The most commonly used combinations include a diuretic; however, results of two large, controlled trials show that better cardiovascular protection is provided by a combination of a renin-angiotensin inhibitor and a long-acting calcium-channel blocker than combinations that include a diuretic.

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References

  1. Jamerson, K. et al. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N. Engl. J. Med. 359, 2417–2428 (2008).

    Article  CAS  Google Scholar 

  2. Rosendorff, C. et al. Treatment of hypertension in the prevention and management of ischemic heart disease: a scientific statement from the American Heart Association Council for High Blood Pressure Research and the Councils on Clinical Cardiology and Epidemiology and Prevention. Circulation 115, 2761–2788 (2007).

    Article  Google Scholar 

  3. Beckett, N. S. et al. Treatment of hypertension in patients 80 years of age or older. N. Engl. J. Med. 358, 1887–1898 (2008).

    Article  CAS  Google Scholar 

  4. Dahlöf, B. et al. Cardiovascular morbidity and mortality in the Losartan Intervention for Endpoint reduction in hypertension study (LIFE): a randomised trial against atenolol. Lancet 359, 995–1003 (2002).

    Article  Google Scholar 

  5. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. 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 288, 2981–2997 (2002).

  6. Dahlöf, B. et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial–Blood Pressure Lowering Arm (ASCOT–BPLA): a multicentre randomised controlled trial. Lancet 366, 895–906 (2005).

    Article  Google Scholar 

  7. Turnbull, F. et al. Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials. BMJ 336, 1121–1123 (2008).

    CAS  PubMed  Google Scholar 

  8. Erikkson, J. W. et al. Hydrochlorothiazide, but not Candesartan, aggravates insulin resistance and causes visceral and hepatic fat accumulation: the mechanisms for the diabetes preventing effect of Candesartan (MEDICA) Study. Hypertension 52, 1030–1037 (2008).

    Article  Google Scholar 

  9. Feig, D., Kang, D. H. & Johnson, R. J. Uric acid and cardiovascular risk. N. Engl. J. Med. 359, 1811–1821 (2008).

    Article  CAS  Google Scholar 

Download references

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Correspondence to Norman M. Kaplan.

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NM Kaplan receives speakers' bureau honoraria from Boehringer-Ingelheim.

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Kaplan, N. Combination therapy for hypertension. Nat Rev Cardiol 6, 270–271 (2009). https://doi.org/10.1038/nrcardio.2009.31

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