Despite recognition that
hypertension is a major risk factor for cardiovascular events and mortality, blood pressure control rates remain low in the US population. Reflecting clinical trial results,
hypertension management guidelines assert the clinical benefit of achieving current blood pressure goals and indicate that most patients will require 2 or more drugs to reach goal. Well-designed
drug combinations counter
hypertension via complementary mechanisms that increase
antihypertensive efficacy, potentially with lower rates of adverse events than higher dose monotherapy regimens. Lower adverse event rates, in turn, may contribute to greater adherence with treatment. The combination of a low-dose
diuretic with agents that block the effects of the renin-angiotensin system (RAS), such as
angiotensin receptor blockers, has been found in numerous clinical trials to be highly effective for lowering blood pressure in patients with uncomplicated as well as high-risk
hypertension, with a comparable favorable side effect profile compared with monotherapy. Moreover, agents that block the RAS are associated with a lower risk of new-onset
diabetes mellitus than other
antihypertensive classes. Complementary combinations of
antihypertensive agents provide an efficient and effective approach to
hypertension management.