Rationale for Triple-Combination Therapy for Management of High Blood Pressure

The goals of antihypertensive therapy include optimal reduction in blood pressure (BP) while providing a favorable tolerability profile that promotes long-term adherence to treatment. For most patients with hypertension, these treatment goals cannot be achieved with monotherapy. When instituted early, however, combination therapy results in more rapid control of BP. This approach may facilitate improvements in long-term clinical outcomes, compared with more traditional and time-consuming stepped care and add-on algorithms for the management of hypertension. This review summarizes the rationale behind combination therapy, specifically triple-combination therapy, and discusses which combinations are most likely to result in better BP control, fewer side effects, and reduced risk of target organ damage. Supporting evidence from recent triple-combination therapy trials also is included in the review. Finally, the role of single-pill (fixed-dose) combination therapy in enhancing patient adherence is also discussed. J Clin Hypertens (Greenwich). 2010;12:869-878.