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Managing hypertension using combination therapy.
Am Fam Physician. 2008 May 01; 77(9):1279-86.AF

Abstract

Combination therapy of hypertension with separate agents or a fixed-dose combination pill offers the potential to lower blood pressure more quickly, obtain target blood pressure, and decrease adverse effects. Antihypertensive agents from different classes may offset adverse reactions from each other, such as a diuretic decreasing edema occurring secondary to treatment with a calcium channel blocker. Most patients with hypertension require more than a single antihypertensive agent, particularly if they have comorbid conditions. Although the Joint National Committee guidelines recommend diuretic therapy as the initial pharmacologic agent for most patients with hypertension, the presence of "compelling indications" may prompt treatment with antihypertensive agents that demonstrate a particular benefit in primary or secondary prevention. Specific recommendations include treatment with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, diuretics, beta blockers, or aldosterone antagonists for hypertensive patients with heart failure. For hypertensive patients with diabetes, recommended treatment includes diuretics, beta blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and/or calcium channel blockers. Recommended treatment for hypertensive patients with increased risk of coronary disease includes a diuretic, beta blockers, angiotensin-converting enzyme inhibitors, and/or calcium channel blocker. The Joint National Committee guidelines recommend beta blockers, angiotensin-converting enzyme inhibitors, and aldosterone antagonists for hypertensive patients who are postmyocardial infarction; angiotensin-converting enzyme inhibitors and angiotensin receptor blockers for hypertensive patients with chronic kidney disease; and diuretic and angiotensin-converting enzyme inhibitors for recurrent stroke prevention in patients with hypertension.

Authors+Show Affiliations

University of Wisconsin, Department of Family Medicine, Appleton, Wisconsin, USA. Jennifer.frank@fammed.wisc.edu

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

18540493

Citation

Frank, Jennifer. "Managing Hypertension Using Combination Therapy." American Family Physician, vol. 77, no. 9, 2008, pp. 1279-86.
Frank J. Managing hypertension using combination therapy. Am Fam Physician. 2008;77(9):1279-86.
Frank, J. (2008). Managing hypertension using combination therapy. American Family Physician, 77(9), 1279-86.
Frank J. Managing Hypertension Using Combination Therapy. Am Fam Physician. 2008 May 1;77(9):1279-86. PubMed PMID: 18540493.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Managing hypertension using combination therapy. A1 - Frank,Jennifer, PY - 2008/6/11/pubmed PY - 2008/6/25/medline PY - 2008/6/11/entrez SP - 1279 EP - 86 JF - American family physician JO - Am Fam Physician VL - 77 IS - 9 N2 - Combination therapy of hypertension with separate agents or a fixed-dose combination pill offers the potential to lower blood pressure more quickly, obtain target blood pressure, and decrease adverse effects. Antihypertensive agents from different classes may offset adverse reactions from each other, such as a diuretic decreasing edema occurring secondary to treatment with a calcium channel blocker. Most patients with hypertension require more than a single antihypertensive agent, particularly if they have comorbid conditions. Although the Joint National Committee guidelines recommend diuretic therapy as the initial pharmacologic agent for most patients with hypertension, the presence of "compelling indications" may prompt treatment with antihypertensive agents that demonstrate a particular benefit in primary or secondary prevention. Specific recommendations include treatment with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, diuretics, beta blockers, or aldosterone antagonists for hypertensive patients with heart failure. For hypertensive patients with diabetes, recommended treatment includes diuretics, beta blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and/or calcium channel blockers. Recommended treatment for hypertensive patients with increased risk of coronary disease includes a diuretic, beta blockers, angiotensin-converting enzyme inhibitors, and/or calcium channel blocker. The Joint National Committee guidelines recommend beta blockers, angiotensin-converting enzyme inhibitors, and aldosterone antagonists for hypertensive patients who are postmyocardial infarction; angiotensin-converting enzyme inhibitors and angiotensin receptor blockers for hypertensive patients with chronic kidney disease; and diuretic and angiotensin-converting enzyme inhibitors for recurrent stroke prevention in patients with hypertension. SN - 0002-838X UR - https://www.unboundmedicine.com/medline/citation/18540493/Managing_hypertension_using_combination_therapy_ DB - PRIME DP - Unbound Medicine ER -