Review: The frequent need for three or more drugs to treat essential hypertension. What evidence for optimal combinations?

Abstract

Treatment of high blood pressure (BP) reduces the risk of death and morbidity from stroke and coronary heart disease. There is accumulating evidence from large outcome studies that support a move towards lower treatment targets in hypertensives, particularly for those with concomitant risk factors or evidence of established target organ damage. At present, the achieved rates for BP control in the UK are very poor. Amongst the many possible reasons for poor BP control is the under utilisation of effective drug combinations. This article addresses the rationale for two and three drug combination therapy in hypertension and reviews the trial evidence for efficacy of combinations.