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Current perspectives on combination therapy in the management of hypertension

Show simple item record Mallat S.G. Itani H.S. Tanios B.Y.
dc.contributor.editor 2013 2017-10-05T15:40:15Z 2017-10-05T15:40:15Z 2013
dc.identifier 10.2147/IBPC.S33985
dc.identifier.issn 11787104
dc.description.abstract Hypertension (HTN) is a worldwide health problem and a major preventable risk factor for cardiovascular (CV) events. Achieving an optimal blood pressure (BP) target for patients with HTN will often require more than one BP-lowering drug. Combination therapy is not only needed, but also confers many advantages such as better efficacy and a better tolerability. A better compliance and simplicity of treatment is noted with the single-pill combination (SPC). In addition, for those patients who do not achieve BP target when receiving dual combinations, triple SPCs are now available, and their efficacy and safety have been tested in large clinical trials. BP-lowering drugs used in combination therapy should have complementary mechanisms of action, leading to an additive BP-lowering effect and improvement in overall tolerability, achieved by decreasing the incidence of adverse effects. On the basis of large, outcome-driven trials, preferred dual combinations include an angiotensin receptor antagonist (ARB) or an angiotensin converting enzyme inhibitor (ACEI) combined with a calcium channel blocker (CCB), or an ARB or ACEI combined with a diuretic. Acceptable dual combinations include a direct rennin inhibitor (DRI) and a CCB, a DRI and a diuretic, a beta-blocker and a diuretic, a CCB and a diuretic, a CCB and a beta-blocker, a dihydropyridine CCB and a non-dihydropyridine CCB, and a thiazide diuretic combined with a potassium-sparing diuretic. Some combinations are not recommended and may even be harmful, such as dual renin angiotensin aldosterone system inhibition. Currently available triple SPCs combine a renin angiotensin aldosterone system inhibitor with a CCB and a diuretic. Combination therapy as an initial approach is advocated in patients with a systolic BP more than 20 mmHg and-or a diastolic BP more than 10 mmHg above target and in patients with high CV risk. In addition, using SPCs has been stressed and favored in recent international guidelines. Recently, triple SPCs have been approved and provide an attractive option for patients not achieving BP target on dual combination. The effect of such a strategy in the overall management of HTN, especially on further reducing the incidence of CV events, will have to be confirmed in future clinical and population-based studies. © 2013 Mallat et al, publisher and licensee Dove Medical Press Ltd.
dc.format.extent Pages: (69-78)
dc.language English
dc.relation.ispartof Publication Name: Integrated Blood Pressure Control; Publication Year: 2013; Volume: 6; Pages: (69-78);
dc.source Scopus
dc.title Current perspectives on combination therapy in the management of hypertension
dc.type Article
dc.contributor.affiliation Mallat, S.G., American University of Beirut, Department of Internal Medicine, Division of Nephrology and Hypertension, Beirut, Lebanon
dc.contributor.affiliation Itani, H.S., American University of Beirut, Department of Internal Medicine, Division of Nephrology and Hypertension, Beirut, Lebanon
dc.contributor.affiliation Tanios, B.Y., American University of Beirut, Department of Internal Medicine, Division of Nephrology and Hypertension, Beirut, Lebanon
dc.contributor.authorAddress Mallat, S. G.; Department of Internal Medicine, American University of Beirut Medical Center, PO Box 11-0236, Riad El-Solh 1107 2020, Beirut, Lebanon; email:
dc.contributor.authorCorporate University: American University of Beirut Medical Center; Faculty: Faculty of Medicine; Department: Internal Medicine; Division: Nephrology;
dc.contributor.authorDepartment Internal Medicine
dc.contributor.authorDivision Nephrology
dc.contributor.authorFaculty Faculty of Medicine
dc.contributor.authorUniversity American University of Beirut Medical Center
dc.description.citedCount 3
dc.format.extentCount 10
dc.identifier.scopusID 84879155045
dc.relation.ispartofPubTitle Integrated Blood Pressure Control
dc.relation.ispartofPubTitleAbbr Integr. Blood Pressure Control
dc.relation.ispartOfVolume 6
dc.type.publication Journal
dc.subject.otherAuthKeyword Combination therapy
dc.subject.otherAuthKeyword Dual combination
dc.subject.otherAuthKeyword Hypertension
dc.subject.otherAuthKeyword Single pill
dc.subject.otherAuthKeyword Triple combination
dc.subject.otherChemCAS aliskiren, 173334-57-1, 173334-58-2, 173399-03-6
dc.subject.otherChemCAS amlodipine, 103129-82-4, 736178-83-9, 88150-42-9
dc.subject.otherChemCAS atenolol, 29122-68-7, 93379-54-5
dc.subject.otherChemCAS bendroflumethiazide, 73-48-3
dc.subject.otherChemCAS chlortalidone, 77-36-1
dc.subject.otherChemCAS clonidine, 4205-90-7, 4205-91-8, 57066-25-8
dc.subject.otherChemCAS doxazosin, 74191-85-8
dc.subject.otherChemCAS hydrochlorothiazide, 58-93-5
dc.subject.otherChemCAS indapamide, 26807-65-8
dc.subject.otherChemCAS methyldopa, 555-29-3, 555-30-6
dc.subject.otherChemCAS perindopril, 82834-16-0, 99149-83-4
dc.subject.otherChemCAS telmisartan, 144701-48-4
dc.subject.otherChemCAS valsartan, 137862-53-4
dc.subject.otherChemCAS verapamil, 152-11-4, 52-53-9
dc.subject.otherIndex aliskiren
dc.subject.otherIndex amlodipine
dc.subject.otherIndex amlodipine plus benazepril
dc.subject.otherIndex angiotensin receptor antagonist
dc.subject.otherIndex antihypertensive agent
dc.subject.otherIndex atenolol
dc.subject.otherIndex azilsartan medoxomil plus chlortalidone
dc.subject.otherIndex bendroflumethiazide
dc.subject.otherIndex beta adrenergic receptor blocking agent
dc.subject.otherIndex calcium channel blocking agent
dc.subject.otherIndex candesartan hexetil plus hydrochlorothiazide
dc.subject.otherIndex chlortalidone
dc.subject.otherIndex clonidine
dc.subject.otherIndex dipeptidyl carboxypeptidase inhibitor
dc.subject.otherIndex direct renin inhibitor
dc.subject.otherIndex diuretic agent
dc.subject.otherIndex doxazosin
dc.subject.otherIndex enalapril plus hydrochlorothiazide
dc.subject.otherIndex hydrochlorothiazide
dc.subject.otherIndex hydrochlorothiazide plus valsartan
dc.subject.otherIndex indapamide
dc.subject.otherIndex methyldopa
dc.subject.otherIndex perindopril
dc.subject.otherIndex potassium sparing diuretic agent
dc.subject.otherIndex renin inhibitor
dc.subject.otherIndex telmisartan
dc.subject.otherIndex thiazide diuretic agent
dc.subject.otherIndex unclassified drug
dc.subject.otherIndex unindexed drug
dc.subject.otherIndex valsartan
dc.subject.otherIndex verapamil
dc.subject.otherIndex adrenergic system
dc.subject.otherIndex antihypertensive activity
dc.subject.otherIndex antihypertensive therapy
dc.subject.otherIndex aorta pressure
dc.subject.otherIndex article
dc.subject.otherIndex blood pressure regulation
dc.subject.otherIndex blood pressure variability
dc.subject.otherIndex blood vessel volume
dc.subject.otherIndex bradycardia
dc.subject.otherIndex cardiovascular risk
dc.subject.otherIndex clinical trial (topic)
dc.subject.otherIndex combination chemotherapy
dc.subject.otherIndex diastolic blood pressure
dc.subject.otherIndex disease classification
dc.subject.otherIndex drug classification
dc.subject.otherIndex drug dosage form comparison
dc.subject.otherIndex drug efficacy
dc.subject.otherIndex drug megadose
dc.subject.otherIndex drug potentiation
dc.subject.otherIndex drug safety
dc.subject.otherIndex drug tolerability
dc.subject.otherIndex drug withdrawal
dc.subject.otherIndex heart block
dc.subject.otherIndex heart output
dc.subject.otherIndex hemodynamic parameters
dc.subject.otherIndex human
dc.subject.otherIndex hyperkalemia
dc.subject.otherIndex hypertension
dc.subject.otherIndex hypertensive crisis
dc.subject.otherIndex hypotension
dc.subject.otherIndex kidney failure
dc.subject.otherIndex patient compliance
dc.subject.otherIndex practice guideline
dc.subject.otherIndex randomized controlled trial (topic)
dc.subject.otherIndex renin angiotensin aldosterone system
dc.subject.otherIndex systolic blood pressure
dc.subject.otherIndex treatment indication
dc.subject.otherIndex treatment response
dc.subject.otherIndex unspecified side effect
dc.subject.otherIndex vascular resistance

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