Rationale for fixed-dose combinations in the treatment of hypertension: the cycle repeats

摘要: Single-drug therapy remains the preferred way to begin treatment of hypertension, although in many patients this is unable bring blood pressure (BP) goal levels. therapy, even when maximally titrated, at best only modestly effective normalising BP Stage-I or II which represents majority hypertensive population. It increasingly appreciated that elusive a ‘normal’ achieved if multi-drug employed. This especially so considered context today’s lower goals. The options for are quite simple: either fixed-dose combination drugs added sequentially one after another then arrive an regimen. Advocates exist both approaches. A considerable legacy, dating 1950’s, exists therapies. rationale approach has remained constant. Fixed-dose successfully reduces because two drugs, each typically working separate site, block different effector pathways. In addition, second drug such two-drug combinations may check counter-regulatory system activity triggered by other. For example, diuretic and β-blocker find correcting salt-and-water retention occasionally accompanies therapy. pattern adverse effects also differs with part, less generally being given. component can effectively counterbalance tendency other produce effects. peripheral oedema, calcium channel antagonist occurs frequently ACE inhibitor co-administered. inhibitors improve, not eliminate, oedema associated antagonists their proven ability cause venodilation. therapy-induced volume contraction generate state secondary hyperaldosteronism thereby electrolyte abnormalities as hypokalaemia and/or hypomagnesaemia. cases, co-administration angiotensin receptor blocker corrects aforementioned disturbances. record reducing BP. form been available close half-century. Over period time, physicians have taken advantage therapeutic academic opinion was than charitable concept. Academic rarely immutable irrelevant prescription practice. Prescription practice driven considerations including ease use, cost tolerance Most importantly, pathway should result reached large number those treated. Unfortunately, despite simplicity concept behind its success will ultimately rest on cost. If made truly cost-competitive, it gain increasing share market. not, market forces relegate role hypertension treatment.