Cardiology Letters 2015, 24(4):230-237

Strategy of combination antihypertensive therapy

Filipová S

Klinika kardiológie a angiológie, Lekárska fakulta Slovenskej zdravotníckej univerzity, Národný ústav srdcových a cievnych chorôb, a.s., Bratislava, Slovenská republika

High blood pressure (BP) as a symptom as well a as clinical disease is caused by multifactorial processes, e.g. on the basis of various pathophysiological "error" events in maintaining the physiological blood flow regulation. Treatment of hypertension may therefore be effective and long-term efficient only if it affects synchronously the many disturbed regulatory areas which maintain the normal function of the cardiovascular (CV) system (heart, central and peripheral arteries) and various other organs (especially kidneys and central nervous system). The vast majority of hypertensive patients require a combination of at least two antihypertensive agents to reach the target blood pressure. Based on knowledge of the hypertension pathophysiology it is possible to stress 3 basic practical clinical conclusions: (1) It is necessary to diagnose hypertension correctly as soon as possible, stratify, and then start the treatment, while (2) in the hypertension treatment it is a pathophysiologically correct to intervene simultaneously in several potential aetiological positions responsible for the rise and maintenance of elevated BP, (3) this treatment should be at the same time act as preventive protection for systems and organs that are most vulnerable to the effects of high BP. The complex and combined pharmacological antihypertensive treatment is therefore lege artis procedure, on the basis of evidence-based medicine (EBM). The aim of this overview is the drug antihypertensive therapy and the decision making process for monotherapy and combination therapy. It describes the principles of correct choice of drug therapy when combining two or more antihypertensive drugs based on EBM. The article specifically covers various aspects of fixed dual combinations and fixed triple combinations in clinical practice. Since hypertension is the largest risk factor for the current overall mortality and CV mortality in the adult population, it is necessary to understand it scientifically at all levels and clinically and to support this in community and health programmes.

Keywords: arterial hypertension; antihypertensive treatment goals; choice of combination therapy; free combinations; fixed dual combinations; fixed triple combinations

Published: April 1, 2015  Show citation