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REVIEW ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 2  |  Page : 78-83

Monotherapy versus combination therapy for the initial treatment of hypertension


Government Medical College, Amritsar, Punjab, India

Correspondence Address:
Dr. Simardeep Kaur Shina
730 Clinton Street, Westbury, New York
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JCPC.JCPC_27_20

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Objectives: There is a significant gap among hypertensive patients who are being treated and those who actually achieve blood pressure (BP) control. The main objective of this article is to determine if there are any differences in clinical outcomes and BP control with a combination treatment as compared to monotherapy as the initial treatment of hypertension. It also focuses on to compare the efficacy and compliance of fixed-dose combination (FDC) as compared to monotherapy and conventional multi-pill combination therapy as the initial treatment of hypertension. Methods: A search of literature was done using PubMed and Google scholar to prepare a review on this topic. Results: The main evidence supporting the use of combination therapy is focused on the use of combinations of renin–angiotensin System (RAS) blocker with calcium channel blockers (CCBs) and with thiazide diuretics. Several randomized clinical trials have proven the efficacy of combination therapy to be superior to monotherapy as initial treatment for timely and adequate BP control. Conclusion: Several benefits of achieving good BP control have been proven by several studies including the Systolic Blood Pressure Intervention Trial study, but only a few guidelines internationally recommend combination antihypertensives as a routine first-line treatment in all hypertensive patients. It is reasonable to go for aggressive management of hypertension involving the use of FDC antihypertensives from two different classes of drugs to achieve the recommended goals of BP of <140/90 mmHg for most patients and <130/80 mmHg for high-risk patients. The combination treatment that can be considered is the combination of RAS blockers with CCB or RAS blockers with thiazide diuretics.


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