Combination therapy in the treatment of hypertension

Carolina Guerrero-García, Alberto Francisco Rubio-Guerra, Carolina Guerrero-García, Alberto Francisco Rubio-Guerra

Abstract

Hypertension is a major preventable risk factor for atherosclerosis and ischemic heart disease. Although modern and effective antihypertensive drugs are available, most patients remain with a suboptimal blood pressure control. Most hypertensive patients will need a combination of antihypertensive agents to achieve the therapeutic goals - recent guidelines recommend initiating treatment with two drugs in those patients with a systolic blood pressure >20 mmHg and/or a diastolic blood pressure >10 mmHg above the goals, and in those patients with high cardiovascular risk. In addition, approximately 25% of patients will require three antihypertensive agents to achieve the therapeutic targets. In this review, we analyse the latest information available regarding the treatment of hypertension with combination therapy.

Keywords: antihypertensive drugs; cardiovascular disease; combination therapy; hypertension; therapeutic goals.

Conflict of interest statement

Disclosure and potential conflicts of interest: The authors declare no conflicts of interest. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors are available for download at http://www.drugsincontext.com/wp-content/uploads/2018/05/dic.212531-COI.pdf

References

    1. Oparil S, Acelajado MC, Bakris GL, Berlowitz DR, Cífková R, Dominiczak AF, Grassi G, Jordan J, Poulter NR, Rodgers A, Whelton PK. Hypertension. Nat Rev Dis Primers. 2018;4:18014. .
    1. Sanchez RA, Ayala M, Baglivo H, Velazquez C, Burlando G, Kohlmann O, Jimenez J, Jaramillo PL, Brandao A, Valdes G, Alcocer L, Bendersky M, Ramirez AJ, Zanchetti A Latin America Expert Group. Latin American guidelines on hypertension. Latin American Expert Group. J Hypertens. 2009;27:905–22. .
    1. Oliva RV, Bakris GL. Management of hypertension in elderly population. J Gerontol Biol Sci Med Sci. 2012;67:1343–51. .
    1. Whelton PK, Carey RM, Aronow WS, Casey DE, Jr, Collins KJ, Dennison Himmelfarb C, DePalma SM, Gidding S, Jamerson KA, Jones DW, MacLaughlin EJ, Muntner P, Ovbiagele B, Smith SC, Jr, Spencer CC, Stafford RS, Taler SJ, Thomas RJ, Williams KA, Sr, Williamson JD, Wright JT., Jr ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017 2017 Nov 7; pii: S0735-1097(17)41519-1. . [Epub ahead of print]
    1. Pimenta E, Oparil S. Fixed combinations in the management of hypertension: patient perspectives and rationale for development and utility of the olmesartan-amlodipine combination. Vasc Health Risk Manag. 2008;4:653–64. .
    1. Volpe M, Gallo G, Tocci G. Is early and fast blood pressure control important in hypertension management? Int J Cardiol. 2018;254:328–32. .
    1. Burnier M. Antihypertensive combination treatment: state of the art. Curr Hypertens Rep. 2015;17:51. .
    1. Wald DS, Law M, Morris JK, Bestwick JP, Wald NJ. Combination therapy versus monotherapy in reducing blood pressure: meta-analysis on 11,000 participants from 42 trials. Am J Med. 2009;122:290–300. .
    1. Rubio-Guerra AF, Castro-Serna D, Elizalde-Barrera CI, Ramos-Brizuela LM. Current concepts in combination therapy for the treatment of hypertension: combined calcium channel blockers and RAAS inhibitors. Integr Blood Press Control. 2009;2:55–62. .
    1. Bakris GL. Combined therapy with a calcium channel blocker and an angiotensin II type 1 receptor blocker. J Clin Hypertens. 2008;10(1 Suppl 1):27–32.
    1. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, Smith SC, Jr, Svetkey LP, Taler SJ, Townsend RR, Wright JT, Jr, Narva AS, Ortiz E. 2014 Evidence-Based guideline for the management of high blood pressure in adults: report from the Panel Members Appointed to the Eighth Joint National Committee (JNC 8) JAMA. 2014;311:507–20. .
    1. Task Force for the management of arterial hypertension of the European Society of Hypertension; Task Force for the management of arterial hypertension of the European Society of Cardiology. 2013 ESH/ESC Guidelines for the Management of Arterial Hypertension. Blood Press. 2013;22:193–278. .
    1. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomized trials in the context of expectations from prospective epidemiological studies. BMJ. 2009 May 19;338:b1665. .
    1. Jamerson K, Weber MA, Bakris GL, Dahlof B, Pitt B, Shi V, Hester A, Gupte J, Gatlin M, Velazquez EJ. Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N Engl J Med. 2008;359:2417–28. .
    1. Mann JF, Schmieder RE, McQueen M, Dyal L, Schumacher H. Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial. Lancet. 2008;372(9638):547–53. .
    1. Escobar C, Barrios V. An evaluation of the latest evidence relating to renin-angiotensin system inhibitors. Expert Opin Drug Metab Toxicol. 2013;9:847–58. .
    1. Williams B, Cockcroft JR, Kario K, Zappe DH, Brunel PC, Wang Q, Guo W. Effects of sacubitril/valsartan versus olmesartan on central hemodynamics in the elderly with systolic hypertension: The PARAMETER Study. Hypertension. 2017;69:411–20. .
    1. Koh KK, Quon MJ, Han SH, Lee Y, Kim SJ, Koh Y, Shin EK. Distinct vascular and metabolic effects of different classes of anti-hypertensive drugs. Int J Cardiol. 2010;140:73–81. .
    1. Poulter NR, Wedel H, Dahlöf B, Sever PS, Beevers DG, Caulfield M, Kjeldsen SE, Kristinsson A, McInnes GT, Mehlsen J, Nieminen M, O’Brien E, Ostergren J, Pocock S ASCOT Investigators. Role of blood pressure and other variables in the differential cardiovascular event rates noted in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA) Lancet. 2005;366(9489):907–13. .
    1. Bakris GL, Molitch M, Hewkin A, Kipnes M, Sarafidis P, Fakouhi K, Bacher P, Sowers J STAR Investigators. Differences in glucose tolerance between fixed-dose antihypertensive drug combinations in people with metabolic syndrome. Diabetes Care. 2006;29:2592–97. .
    1. Rubio-Guerra AF, Vargas-Robles H, Vargas-Ayala G, Rodríguez-Lopez L, Castro-Serna D, Escalante-Acosta BA. Impact of trandolapril therapy and its combination with a calcium channel blocker on plasma adiponectin levels in patients with type 2 diabetes and hypertension. Ther Adv Cardiovasc Dis. 2011;5:193–7. .
    1. Rubio-Guerra AF, Vargas-Robles H, Lozano-Nuevo JJ, Elizalde-Barrera CI, Huerta-Ramírez S, Escalante-Acosta BA. Beneficial effect of combination therapy with an angiotensin-converting enzyme inhibitor plus verapamil on circulating resistin levels in hypertensive patients with type-2 diabetes. Exp Clin Cardiol. 2012;17:202–4.
    1. Martinez-Martin FJ, Rodriguez-Rosas H, Peiro-Martinez I, Soriano-Perera P, Pedrianes-Martin P, Comi-Diaz C. Olmesartan/amlodipine vs olmesartan/hydrochlorothiazide in hypertensive patients with metabolic syndrome: the OLAS study. J Hum Hypertens. 2011;25:346–53. .
    1. Ruggenenti P, Fassi A, Ilieva AP. Preventing microalbuminuria in type 2 diabetic patients. N Engl J Med. 2004;351:1941–51. .
    1. Patel A, Macmahon S, Chalmers J. Effects of a fixed dose combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (The ADVANCED trial) Lancet. 2007;370:829–40. .
    1. Bakris GL, Sarafidis PA, Weir MR, Dahlöf B, Pitt B, Jamerson K, Velazquez EJ, Staikos-Byrne L, Kelly RY, Shi V, Chiang YT, Weber MA for the ACCOMPLISH Trial investigators. Renal outcomes with different fixed-dose combination therapies in patients with hypertension at high risk for cardiovascular events (ACCOMPLISH): a prespecified secondary analysis of a randomized controlled trial. Lancet. 2010;375:1173–81. .
    1. Rubio AF, Arceo A, Vargas G, Rodríguez L, Lozano J, Treviño C. The effect of trandolapril and its fixed-dose combination with verapamil on proteinuria in normotensive adults with type 2 diabetes. Diabetes Care. 2004;27:1688–91. .
    1. Rubio AF, Treviño CJ, Vargas G, Narváez JL, Lozano JJ, Rodríguez L. Renoprotective effects of the combination trandolapril/verapamil in patients with type 2 diabetes mellitus and hypertension. Clin Drug Invest. 2002;22:541–6. .
    1. Matsui Y, Eguchi K, O’Rourke MF, Ishikawa J, Miyashita H, Shimada K, Kario K. Differential effects between a calcium channel blocker and a diuretic when used in combination with angiotensin II receptor blocker on central aortic pressure in hypertensive patients. Hypertension. 2009;54:716–23. .
    1. Khan BV, Merchant N, Rahman ST, Ahmad M, Parrott JM, Umar K, Johnson J, Ferdinand KC. Changes in central aortic pressure, endothelial function and biomarkers in hypertensive African-Americans with the cardiometabolic syndrome: comparison of amlodipine/olmesartan versus hydrochlorothiazide/losartan. Cardiorenal Med. 2013;3:221–31. .
    1. Williams B, Lacy PS, Thom SM, Cruickshank K, Stanton A, Collier D, Hughes AD, Thurston H, O’Rourke M CAFE Investigators; Anglo-Scandinavian Cardiac Outcomes Trial Investigators; CAFE Steering Committee and Writing Committee. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation. 2006 Mar 7;113(9):1213–25. .
    1. Ogihara T, Saruta T, Rakugi H, Saito I, Shimamoto K, Matsuoka H for the COLM Investigators. Combinations of olmesartan and a calcium channel blocker or a diuretic in elderly hypertensive patients: a randomized, controlled trial. J Hypertens. 2014;32:2054–63. .
    1. Ogihara T, Saruta T, Rakugi H, Saito I, Shimamoto K, Matsuoka H for the COLM Investigators. Combination therapy of hypertension in the elderly: a subgroup analysis of the combination of OLMesartan and a calcium channel blocker or diuretic in Japanese elderly hypertensive patients trial. Hypertens Res. 2015;38:89–96. .
    1. Thijs L, Richart T, de Leeuw PW, Kuznetsova T, Grodzicki T, Kawecka-Jaszcz K, O’Brien E, Redón J, Birkenhäger WH, Fagard R, Staessen JA. Morbidity and mortality on combination versus monotherapy: a posthoc analysis of the Systolic Hypertension in Europe trial. J Hypertens. 2010;28:865–74. .
    1. Ghiadoni L, Magagna A, Kardasz I, Taddei S, Salvetti A. Fixed dose combination of perindopril and indapamide improves peripheral vascular function in essential hypertensive patients. Am J Hypertens. 2009;22:506–12. .
    1. Versari D, Virdis A, Ghiadoni L, Daghini E, Duranti E, Masi S, Magagna A, Taddei S. Effect of verapamil, trandolapril and their combination on vascular function and structure in essential hypertensive patients. Atherosclerosis. 2009;205:214–20. .
    1. Neutel JM, Smith DH, Weber MA. Effect of antihypertensive monotherapy and combination therapy on arterial distensibility and left ventricular mass. Am J Hypertens. 2004;17:37–42. .
    1. Zhou T, Huang X, Cai X, Xie L. Combined treatment of irbesartan and diltiazem ameliorates endothelium dependent vasodilatation in hypertensives. Clin Exp Hypertens. 2017;39:612–18. .
    1. Siragy HM, Xue C, Webb RL. Beneficial effects of combined benazepril-amlodipine on cardiac nitric oxide, cGMP, and TNF-α production after cardiac ischemia. J Cardiovasc Pharmacol. 2006;47:636–42. .
    1. Rubio-Guerra AF, Vargas-Robles H, Vargas-Ayala G, Rodríguez-Lopez L, Escalante-Acosta BA. The effect of trandolapril and its fixed-dose combination with verapamil on circulating adhesion molecules levels in hypertensive patients with type 2 diabetes. Clin Exp Hypertens. 2008;30:682–8. .
    1. Riva N, Lip GY. Which is the optimal antihypertensive combination in different diseases, a renin- angiotensin-aldosterone system inhibitor with a diuretic or with a calcium channel blocker? Curr Pharm Des. 2013;19:3753–65. .
    1. Rubio-Guerra AF, Garro-Almendaro AK, Elizalde-Barrera CI, Suarez-Cuenca JA, Duran-Salgado MB. Effect of losartan combined with amlodipine or with a thiazide on uric acid levels in hypertensive patients. Ther Adv Cardiovasc Dis. 2017;11:57–62. .
    1. Krause T, Lovibond K, Caulfield M, McCormack T, Williams B Guideline Development Group. Management of hypertension: summary of NICE guidance. BMJ. 2011;343:d4891. .
    1. Chi C, Tai C, Bai B, Yu S, Karamanou M, Wang J, Protogerou A, Blacher J, Safar ME, Zhang Y, Xu Y. Angiotensin system blockade combined with calcium channel blockers is superior to other combinations in cardiovascular protection with similar blood pressure reduction: a meta-analysis in 20,451 hypertensive patients. J Clin Hypertens (Greenwich) 2016;18:801–8. .
    1. Remonti LR, Dias S, Leitão CB, Kramer CK, Klassman LP, Welton NJ, Ades AE, Gross JL. Classes of antihypertensive agents and mortality in hypertensive patients with type 2 diabetes-Network meta-analysis of randomized trials. J Diabetes Complications. 2016;30:1192–200. .
    1. Dorsch MP, Gillespie BW, Erickson SR, Bleske BE, Weder AB. Chlorthalidone reduces cardiovascular events compared with hydrochlorothiazide: a retrospective cohort analysis. Hypertension. 2011;57:689–94. .
    1. Gudsoorkar PS, Tobe SW. Changing concepts in hypertension management. J Hum Hypertens. 2017;31:763–7. .
    1. Tóth K PIANIST Investigators. Antihypertensive efficacy of triple combination perindopril/indapamide plus amlodipine in high-risk hypertensives: results of the PIANIST study (Perindopril-Indapamide plus AmlodipiNe in high rISk hyperTensive patients) Am J Cardiovasc Drugs. 2014;14:137–45. .

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere