Professor Giuseppe Mancia’s presentation reviews the latest evidence and recommendations about lowering blood pressure (BP). Considering that monotherapy provides BP control only for a limited number of hypertensive patients, the need for a combination treatment emerges. According to European guidelines and clinical studies:
- Combination therapy begins later than it should according to guidelines recommendations.
- Stepped care therapy needs at least 2 drugs for BP control, but it presents a non-homogeneous level of adherence.
- Single pill (double) combination therapy provides higher adherence and BP control than monotherapy, and a lower CV risk.
- Therapeutic efficacy and adherence further increase with triple combination therapy.
The actual drug treatment recommendation includes 3 steps:
- Dual drug combination (ACE inhibitors (ACEi) or Angiotensin 2 receptors blockers (ARB) + Calcium channel blockers (CCB) or thiazide or thiazide like).
- Triple combination (ACEi or ARB + CCB + thiazide or thiazide like).
- Triple combination + other drugs (diuretics).
Despite the benefits and the guidelines recommendations, there is still a lack in clinical practice for combination treatment use.