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Review Article

Rationale for Fixed-Dose Combination Therapy to Reach Lower Blood Pressure Goals

Jan N. Basile, MD
Volume: 101 Issue: 9 September, 2008

Abstract:

Expert committees in the United States and Europe formulated their currently recommended target blood pressures of <140/90 mm Hg or <130/80 mm Hg in persons with diabetes, chronic kidney disease, or coronary artery disease based on the totality of clinical data available at the time. However, accumulating evidence indicates that increased risk for cardiovascular and renal complications of hypertension may begin at a threshold of 115/75 mm Hg, suggesting that benefit from treatment may occur when blood pressure targets are lower than those currently recommended. Combination therapy with two or more agents having complementary mechanisms of action is the most effective method for achieving strict blood pressure goals in high-risk patients. Several clinical trials are under way to further determine the risks and benefits of lowering blood pressure beyond the currently recommended threshold.


Key Points


* Lowering blood pressure to levels below currently recommended goals may improve cardiovascular outcomes, especially in high-risk patients.


* The aggressive blood pressure goals needed to reduce risk in high-risk patients may be difficult to achieve.


* Most high-risk patients will require more than one antihypertensive agent to achieve their goal.


* Fixed-dose combination therapy offers a number of potential advantages over two drugs given separately.

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