J Korean Med Assoc.  2014 Mar;57(3):253-258. 10.5124/jkma.2014.57.3.253.

Antihypertensive drug combinations

• Park JB

• KMID: 2064882
• DOI: http://doi.org/10.5124/jkma.2014.57.3.253

Abstract

Hypertension has a diverse pathophysiology. Theoretically, one drug is not sufficient to control high blood pressure (BP) in most hypertension. Therefore, the combination of two or more drugs with different mechanisms is needed to meet the target BP. In setting the target BP, a low-dose combination of two drugs with different mechanisms has greater efficacy and safety than a higher dose of one drug. Recent clinical trials and hypertension guidelines from different parts of the world report that the combination of renin-angiotensin system inhibitors with calcium channel antagonists or diuretics is generally recommended but combinations including beta-blockers, rarely so. However, if even a combination of three drugs all with different mechanisms, each at full dose does not control the BP, then a beta-blocker and/or other antihypertensive drug should be considered. Rarely, an interventional procedure such as renal sympathetic denervation has been applied, but evidence supporting such therapies remains limited.

Keyword

Hypertension; Drug; Combination drug therapy

MeSH Terms

Calcium Channels
Diuretics
Drug Combinations*
Drug Therapy, Combination
Hypertension
Renin-Angiotensin System
Sympathectomy
Calcium Channels
Diuretics
Drug Combinations

Figure

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  Figure 1 A diverse pathophysiology of hypertension development. Hemodynamic and neuro-hormonal changes contribute blood pressure elevation and vascular alterations. SNS, sympathetic nerve system; RAS, renin angiotensin system.

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  Figure 2 Monotherapy or drug combination strategies to achieve target blood pressure. Moving from monotherapy to quadruple therapy and with interventional approach as an option should be done whenever blood pressure target is not achieved. CV, cardiovascular. A, angiotensin converting enzyme inhibitor or angiotensin receptor blocker; B, beta-blockers; C, calcium channel blocker; D, thiazide or thiazide-like diuretic; E, et cetera (alpha- or beta-blocker, spinolactone, loop diuretic and others).

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  Figure 3 Preferred, and acceptable combinations of antihypertensive drugs. A, angiotensin converting enzyme inhibitor or angiotensin receptor blocker; B, beta-blocker; C, calcium channel blocker; D, thiazide or thiazide-like diuretic. Modified from Korean Society of Hypertension. 2013 Guideline on hypertension by Korean Society of Hypertension [Internet]. Seoul: Korean Society of Hypertension; 2013 [1].

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