» Articles » PMID: 15722654

Combination Therapy in the Management of Hypertension: Focus on Angiotensin Receptor Blockers Combined with Diuretics

Overview
Date 2005 Feb 22
PMID 15722654
Citations 6
Authors
Affiliations
Soon will be listed here.
Abstract

There is increasing evidence that combination therapy should be emphasized more than it is at present for the initial treatment of hypertensive patients. Recent guidelines acknowledge the value of combination therapy, although some treatment algorithms fail to echo this message. Observations from major clinical trials in the elderly, diabetics, stroke patients, and African Americans all indicate that combination therapy is necessary to control blood pressure in the majority of these patients. Several combination therapies such as an angiotensin II receptor blocker and a diuretic, an angiotensin-converting enzyme inhibitor with a diuretic, a beta blocker with a diuretic, or an angiotensin-converting enzyme inhibitor with a calcium antagonist have been shown to be effective in patients who do not respond to monotherapy. The current review focuses on the newest such combination; an angiotensin II receptor blocker and a diuretic may have an added advantage of being well tolerated. Recent studies have shown that angiotensin II receptor blockers, given alone or combined with a diuretic, may prevent some cardiovascular outcomes independent of their blood pressure-lowering efficacy.

Citing Articles

Comparative Effectiveness of Angiotensin II Receptor Blockers in Patients With Hypertension in Japan - Systematic Review and Network Meta-Analysis.

Nakajima T, Oh A, Saita S, Yoshida T, Ohishi M, Nishigaki N Circ Rep. 2021; 2(10):576-586.

PMID: 33693183 PMC: 7932820. DOI: 10.1253/circrep.CR-20-0076.


Fimasartan versus perindopril with and without diuretics in the treatment of elderly patients with essential hypertension (Fimasartan in the Senior Subjects (FITNESS)): study protocol for a randomized controlled trial.

Kang M, Kim K, Ihm S, Rhee M, Sohn I, Lee H Trials. 2019; 20(1):389.

PMID: 31262348 PMC: 6604456. DOI: 10.1186/s13063-019-3466-5.


Effectiveness of hydrochlorothiazide in combination with telmisartan and olmesartan in adults with moderate hypertension not controlled with monotherapy: a prospective, randomized, open-label, blinded end point (PROBE), parallel-arm study.

Fogari R, Zoppi A, Mugellini A, Preti P, Destro M, Rinaldi A Curr Ther Res Clin Exp. 2014; 69(1):1-15.

PMID: 24692778 PMC: 3969955. DOI: 10.1016/j.curtheres.2008.02.003.


Efficacy and safety of a fixed combination of irbesartan/hydrochlorothiazide in Chinese patients with moderate to severe hypertension.

Huang Q, Sheng C, Li Y, Ma G, Dai Q, Wang J Drugs R D. 2013; 13(2):109-17.

PMID: 23605903 PMC: 3689903. DOI: 10.1007/s40268-013-0013-9.


The role of baseline blood pressure in guiding treatment choice: a secondary analysis of the use of valsartan/hydrochlorothiazide as initial therapy in hypertensive adults in a randomized, double-blind, placebo-controlled trial.

Pool J, Glazer R, Crikelair N, Levy D Clin Drug Investig. 2009; 29(12):791-802.

PMID: 19888785 DOI: 10.2165/11530600-000000000-00000.


References
1.
McInnes G, OKane K, Istad H, Keinanen-Kiukaanniemi S, Van Mierlo H . Comparison of the AT1-receptor blocker, candesartan cilexetil, and the ACE inhibitor, lisinopril, in fixed combination with low dose hydrochlorothiazide in hypertensive patients. J Hum Hypertens. 2000; 14(4):263-9. DOI: 10.1038/sj.jhh.1000997. View

2.
Townsend R, Haggert B, Liss C, Edelman J . Efficacy and tolerability of losartan versus enalapril alone or in combination with hydrochlorothiazide in patients with essential hypertension. Clin Ther. 1995; 17(5):911-23. DOI: 10.1016/0149-2918(95)80069-7. View

3.
Wing L, Reid C, Ryan P, Beilin L, Brown M, Jennings G . A comparison of outcomes with angiotensin-converting--enzyme inhibitors and diuretics for hypertension in the elderly. N Engl J Med. 2003; 348(7):583-92. DOI: 10.1056/NEJMoa021716. View

4.
Malacco E, Santonastaso M, Vari N, Gargiulo A, Spagnuolo V, Bertocchi F . Comparison of valsartan 160 mg with lisinopril 20 mg, given as monotherapy or in combination with a diuretic, for the treatment of hypertension: the Blood Pressure Reduction and Tolerability of Valsartan in Comparison with Lisinopril (PREVAIL) study. Clin Ther. 2004; 26(6):855-65. DOI: 10.1016/s0149-2918(04)90129-4. View

5.
Franco R, Goldflus S, McQuitty M, Oigman W . Efficacy and tolerability of the combination valsartan/hydrochlorothiazide compared with amlodipine in a mild-to-moderately hypertensive Brazilian population. Blood Press Suppl. 2004; 2:41-7. View