American Journal of Cardiovascular Drugs

, Volume 9, Issue 1, pp 1–6 | Cite as

Combination Therapy as First-Line Treatment for Hypertension

  • Michael H. Crawford
Current Opinion


Systemic hypertension is a long-term risk factor for the development of atherosclerotic vascular disease and when uncontrolled is a short-term trigger of acute vascular events such as acute coronary syndromes and stroke. Thus, rapid reduction in BP is desirable. Patients at high risk for vascular disease, such as those with diabetes mellitus, have aggressive goal BP targets because studies have shown that achieving these targets reduces events. Given the dual goals in high-risk patients of reducing BP quickly and to aggressively low targets, the classic ‘step therapy’ of one drug titrated at a time to reduce BP is inadequate. Combination therapy with at least two potent medications makes more sense, and manufacturers are now increasing their offerings of single-pill combinations for hypertension. Combination pills are popular with patients and increase compliance with therapy. Many believe that renin-angiotensin aldosterone system (RAAS) blockers are the cornerstone of hypertension treatment in patients at high risk for vascular disease. The newer combination pills include a RAAS blocker and diuretics or a long-acting calcium channel antagonist (CCA). Recent studies have shown that a RAAS blocker plus a dihydropyridine CCA is superior to older diuretic-based combinations for preventing cardiovascular events. These considerations support a new approach to the higher risk hypertensive patient: effective doses of RAAS blocker/CCA combination pills to rapidly lower BP to <130/80 mmHg.


Amlodipine Valsartan Calcium Channel Antagonist Thiazide Diuretic Benazepril 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Dr Crawford has received honoraria for speaking from Pfizer, Novartis, AstraZeneca, and Abbott pharmaceutical companies in the last 2 years. Funding to support the preparation of this manuscript was provided by Novartis Pharmaceutical Corporation. The views expressed in this review are those of the author.


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© Adis Data Information BV 2009

Authors and Affiliations

  1. 1.Division of Cardiology, Department of MedicineUniversity of California, San Francisco (UCSF)San FranciscoUSA

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