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According to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7), the blood pressure can be controlled earlier when the treatment for newly diagnosed hypertension is initiated with more than one drug. This is especially recommended for cases where the blood pressure is more than 20/10 mm of Hg above the normal blood pressure. However, there is a limited data regarding the combination of drugs used and their effect on controlling blood pressure. A new study, which has been published in the “American Heart Journal”, examined the effect of combination antihypertensive therapy on 12 month blood pressure control.

 

The researchers selected 161,585 patients with newly diagnosed hypertension, from the Cardiovascular Research Network Hypertension Registry, who were being treated with combination antihypertensive therapy,  between the years 2002 and 2007. They found an increasing trend among physicians for using combination therapy to treat incidental hypertension. While 20.7% of such patients were treated with combination therapy in 2002, their percentage increased to 35.8% in 2007. The use of combination therapy was more pronounced in patients who were diagnosed with stage 2 hypertension, wherein the use of this therapy increased from 21.6% in 2002 to 44.5% in 2007. In 90% of times, the combination of drugs used were thiazides with potassium sparing diuretics (47.6%), or  thiazides with angiotensin converting enzyme inhibitors (41.4%). The researchers concluded that 12 month blood pressure control is achieved earlier when a combination therapy of antihypertensive medicines is used. However, this should include a strict adherence to medication dosage and schedule and intensification of treatment if required.

 

Clinical trials have demonstrated that in majority of hypertensive patients, it is very difficult to achieve optimal blood pressure with the use of a single drug. So it is better to opt for a combination therapy. Moreover, combination therapy gives the advantage of using drugs with complementary mechanisms of action in lower doses, thus preventing their side effects.

 

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