BP managementRationale for combination therapy

BP lowering Drug Efficacy - Monotherapy

Law MR, et al. BMJ 2003

Fall in BP (mmHg)Standard dose Twice standard dose

Systolic BP Thiazides 8.8 10.3 β blockers 9.2 11.1 ACE inhibitors 8.5 10.0 Angiotensin II receptor antagonists 10.3 12.3 CCB 8.8 11.7All categories: average 9.1 10.9Diastolic BP Thiazides 4.4 5.0 β blockers 6.7 7.8 ACE inhibitors 4.7 5.7 Angiotensin II receptor antagonists 5.7 6.5 CCB 5.9 7.9All categories: average 5.5 6.5

The importance of combination therapy• About half of patients with hypertension require two or more drugs for

adequate hypertensive control1

• The importance of combination therapy is reflected in current guidance for the management of hypertension1,2

• Combination therapy is especially important in the management of patients with diabetes and hypertension; two or more drugs are often needed to obtain the target blood pressure of 130/80 mm Hg2

• The initiation of combination therapy may increase the chance of achieving blood pressure control in a timely fashion2

1. Van Swieten PA. ESC Scientific Newsletter 2003; 4: 1–2.2. Chobanian AV, et al. JAMA 2003; 289(19): 2560–2572.

Use of combination therapy in clinical practice

•Rigorous blood pressure control with a combination of agents is still rare in clinical practice1

•Combination therapy, using low doses of two or more agents, increases blood pressure control and improves tolerability, compared with monotherapy2

•Prescribing habits must change to prevent the continued rise of cardiovascular complications1

1. McInnes GT. J Hypertens Suppl 2005; 23: S3–S8.2. Dahlöf B. Am J Hypertens 2004; 17: S248.

Effect of two drugs in combination

Law MR, et al. BMJ 2003