A
meta-analysis of more than 40 studies has shown that combining two agents from
any two classes of antihypertensive drugs increases the BP reduction much more
than increasing the dose of one agent.
A
recent survey has shown that patients receiving combination therapy have a
lower drop-out rate than patients given any mono-therapy (because of a lower
probability of discouraging patient adherence with many treatment changes).
Preferred drug combinations:
·
ACE
inhibitor and diuretic combination
·
calcium
antagonist and diuretic combination
·
In
two trials angiotensin receptor blocker–diuretic combination or a calcium
antagonist–ACE inhibitor combination were superior to a beta-blocker–diuretic
combination in reducing CV events
·
Beta-blocker–diuretic
combination appears to elicit more cases of new-onset diabetes in susceptible
individuals, compared with other combinations.
·
Combination
of two renin–angiotensin–system blockers /ACE-I + ARB (ESRD) or RAS blocker + renin inhibitor (stroke)
not recommended because of concerns of hyperkalemia, low blood pressure, and
kidney failure.
Fixed-dose or single-pill
combinations:
§ Combinations of two antihypertensive drugs at
fixed doses in a single tablet may be recommended & favored, because
reducing the number of daily pills improves adherence, which is low in Patients
with hypertension.
Source:
Dr.Qurat-ul-Ain Hafeez, Pharm-D, RPh.
Ambulatory Care Pharmacist, Aga khan University Hospital, Karachi , Pakistan
Facebook: Qurat Hafeez
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