The morbidity and mortality benefits of lowering blood pressure (BP) in hypertensive patients are well established, with most individuals requiring multiple agents to achieve BP control. Considering the important role of the renin-angiotensin-aldosterone system (RAAS) in the pathophysiology of
hypertension, a key component of combination
therapy should include a RAAS inhibitor.
Angiotensin receptor blockers (ARBs) lower BP, reduce cardiovascular risk, provide organ protection, and are among the best tolerated class of
antihypertensive therapy. In this article, we discuss two ARB combinations (
valsartan/
hydrochlorothiazide [
HCTZ] and
amlodipine/valsartan), both of which are indicated for the treatment of
hypertension in patients not adequately controlled on monotherapy and as initial
therapy in patients likely to need multiple drugs to achieve BP goals. Randomized, double-blind studies that have assessed the
antihypertensive efficacy and safety of these combinations in the first-line treatment of hypertensive patients are reviewed. Both
valsartan/
HCTZ and
amlodipine/valsartan effectively lower BP and are well tolerated in a broad range of patients with
hypertension, including difficult-to-treat populations such as those with severe BP elevations,
prediabetes and diabetes, patients with the
cardiometabolic syndrome, and individuals who are obese, elderly, or black. Also discussed herein are patient-focused perspectives related to the use of
valsartan/
HCTZ and
amlodipine/valsartan, and the rationale for use of single-pill combinations as one approach to enhance patient compliance with
antihypertensive therapy.