BP lowering Drug Efficacy Monotherapy Law MR et al BMJ 2003 Fall in BP mmHg Standard dose Twice standard dose Systolic BP Thiazides 88 103 β blockers 92 111 ACE inhibitors ID: 1036039
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1. BP managementRationale for combination therapy
2. BP lowering Drug Efficacy - MonotherapyLaw MR, et al. BMJ 2003Fall in BP (mmHg)Standard doseTwice standard doseSystolic BP Thiazides8.810.3 β blockers9.211.1 ACE inhibitors8.510.0 Angiotensin II receptor antagonists10.312.3 CCB8.811.7All categories: average9.110.9Diastolic BP Thiazides4.45.0 β blockers6.77.8 ACE inhibitors4.75.7 Angiotensin II receptor antagonists5.76.5 CCB5.97.9All categories: average5.56.5
3. The importance of combination therapyAbout half of patients with hypertension require two or more drugs for adequate hypertensive control1The importance of combination therapy is reflected in current guidance for the management of hypertension1,2Combination therapy is especially important in the management of patients with diabetes and hypertension; two or more drugs are often needed to obtain the target blood pressure of 130/80 mm Hg2The initiation of combination therapy may increase the chance of achieving blood pressure control in a timely fashion2Van Swieten PA. ESC Scientific Newsletter 2003; 4: 1–2.Chobanian AV, et al. JAMA 2003; 289(19): 2560–2572.
4. Use of combination therapy in clinical practiceRigorous blood pressure control with a combination of agents is still rare in clinical practice1Combination therapy, using low doses of two or more agents, increases blood pressure control and improves tolerability, compared with monotherapy2Prescribing habits must change to prevent the continued rise of cardiovascular complications1McInnes GT. J Hypertens Suppl 2005; 23: S3–S8.Dahlöf B. Am J Hypertens 2004; 17: S248.
5. Effect of two drugs in combinationLaw MR, et al. BMJ 2003