COMBINATION THERAPY AS INITIAL TREATMENT FOR HYPERTENSION: A SYSTEMATIC REVIEW
Keywords:
Combination therapy, Hypertension, Initial treatment, Monotherapy, QuadripillsAbstract
Hypertension is a modifiable risk factor for cardiovascular disease, the leading cause of mortality in the world, and cardiovascular disease is a risk that may be minimized by managing hypertension. Even within the normal range, even a little elevation in blood pressure is associated with an increased risk. More than 70% of persons being treated for primary hypertension will eventually require the use of at least two antihypertensive drugs. Seventy percent or more of persons treated for primary hypertension will require at least two antihypertensive drugs, either initially as combination therapy or as add-on therapy if monotherapy and lifestyle modifications do not offer adequate blood pressure control. Combination therapy for the treatment of hypertension employs four key medication classes: thiazide diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin receptor blockers (ARBs). Since 2003, individuals with hypertension have been prescribed two medications. Several people require dual antihypertensive medication treatment, which has been shown to be helpful, particularly for those with blood pressure >160/90 mmHg.
References
Lennon RP, Claussen KA, Kuersteiner KA. State of the heart: an overview of the disease burden of cardiovascular disease from an epidemiologic perspective. Prim Care Clin Off Pract. 2018;45(1):1–15.
Kannel WB. Hypertension: reflections on risks and prognostication. Med Clin North Am. 2009;93(3):541–58.
Ogedegbe G, Pickering T. Principles and techniques of blood pressure measurement. Cardiol Clin. 2010 Nov;28(4):571–86.
Zipes D, Libby P, Bonow R. Braunwald’s Heart Disease. 8th ed. Philadelphia: Elsevier; 2019.
Herman LL, Padala SA, Ahmed I, Bashir K. Angiotensin Converting Enzyme Inhibitors (ACEI). In Treasure Island (FL); 2022.
Gan Z, Huang D, Jiang J, Li Y, Li H, Ke Y. Captopril alleviates hypertension-induced renal damage, inflammation, and NF-κB activation. Brazilian J Med Biol Res = Rev Bras Pesqui medicas e Biol. 2018 Sep;51(11):e7338.
Whelton PK, Carey RM. The 2017 American College of Cardiology/American Heart Association clinical practice guideline for high blood pressure in adults. JAMA Cardiol. 2018;3(4):352–3.
Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). Eur Heart J. 2018;39(33):3021–104.
James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). Jama. 2014;311(5):507–20.
Chow CK, Atkins ER, Hillis GS, Nelson MR, Reid CM, Schlaich MP, et al. Initial treatment with a single pill containing quadruple combination of quarter doses of blood pressure medicines versus standard dose monotherapy in patients with hypertension (QUARTET): a phase 3, randomised, double-blind, active-controlled trial. Lancet (London, England). 2021 Sep;398(10305):1043–52.
MacDonald TM, Williams B, Webb DJ, Morant S, Caulfield M, Cruickshank JK, et al. Combination Therapy Is Superior to Sequential Monotherapy for the Initial Treatment of Hypertension: A Double-Blind Randomized Controlled Trial. J Am Heart Assoc. 2017 Nov;6(11).
Chow CK, Thakkar J, Bennett A, Hillis G, Burke M, Usherwood T, et al. Quarter-dose quadruple combination therapy for initial treatment of hypertension: placebo-controlled, crossover, randomised trial and systematic review. Lancet (London, England). 2017 Mar;389(10073):1035–42.
Smith DK, Lennon RP, Carlsgaard PB. Managing Hypertension Using Combination Therapy. Am Fam Physician. 2020 Mar;101(6):341–9.
Byrd JB, Zeng C, Tavel HM, Magid DJ, O’Connor PJ, Margolis KL, et al. Combination therapy as initial treatment for newly diagnosed hypertension. Am Heart J. 2011 Aug;162(2):340–6.
Atkins ER, Chow CK. Low-Dose Combination Therapy for Initial Treatment of Hypertension. Curr Hypertens Rep. 2020 Aug;22(9):65.
MacDonald TM, Williams B, Caulfield M, Cruickshank JK, McInnes G, Sever P, et al. Monotherapy versus dual therapy for the initial treatment of hypertension (PATHWAY-1): a randomised double-blind controlled trial. BMJ Open. 2015 Aug;5(8):e007645.
Tedesco MA, Natale F, Calabrò R. Effects of monotherapy and combination therapy on blood pressure control and target organ damage: a randomized prospective intervention study in a large population of hypertensive patients. J Clin Hypertens. 2006;8(9):634–41.
Salam A, Kanukula R, Atkins E, Wang X, Islam S, Kishore SP, et al. Efficacy and safety of dual combination therapy of blood pressure-lowering drugs as initial treatment for hypertension: a systematic review and meta-analysis of randomized controlled trials. J Hypertens. 2019;37(9):1768–74.
Egan BM, Bandyopadhyay D, Shaftman SR, Wagner CS, Zhao Y, Yu-Isenberg KS. Initial monotherapy and combination therapy and hypertension control the first year. Hypertension. 2012;59(6):1124–31.
Cifu AS, Davis AM. Prevention, detection, evaluation, and management of high blood pressure in adults. Jama. 2017;318(21):2132–4.
Carey RM, Whelton PK, Committee* 2017 ACC/AHA Hypertension Guideline Writing. Prevention, detection, evaluation, and management of high blood pressure in adults: synopsis of the 2017 American College of Cardiology/American Heart Association Hypertension Guideline. Ann Intern Med. 2018;168(5):351–8.
Düsing R, Waeber B, Destro M, Santos Maia C, Brunel P. Triple-combination therapy in the treatment of hypertension: a review of the evidence. J Hum Hypertens. 2017 Aug;31(8):501–10.
Tsioufis C, Thomopoulos C. Combination drug treatment in hypertension. Pharmacol Res. 2017 Nov;125(Pt B):266– 71.
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Licensing
Ninety Nine Publication publishes articles under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This licensing allows for any use of the work, provided the original author(s) and source are credited, thereby facilitating the free exchange and use of research for the advancement of knowledge.
Detailed Licensing Terms
Attribution (BY): Users must give appropriate credit, provide a link to the license, and indicate if changes were made. Users may do so in any reasonable manner, but not in any way that suggests the licensor endorses them or their use.
No Additional Restrictions: Users may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
