| Abstract text: |
It has long been known that increased blood pressure (BP) is a risk factor for cerebrovascular and cardiovascular (CV) mortality. Hypertension represents one of the three leading causes of visits in primary healthcare centers. Data from the Framingham study suggests that 80% of hypertensive patients have at least one additional CV risk factor. These additional risk factors tend to cluster and include glucose intolerance, obesity, left ventricular hypertrophy and dyslipidaemia. Among patients with hypertension, about 40% of coronary events in men and 68% in women are attributable to the presence of two or more additional CV risk factors. The observation that initiating treatment with combination therapy can have long-term benefits is reflected in the 2007 European Society of Hypertension (ESH) /European Society of Cardiology (ESC) guidelines. These recommend a two-drug combination at low dose as first-line treatment rather than monotherapy in patients presenting with grade 2 or 3 hypertension or with high or very high total CV risk or who have a lower target BP. Advantages of dwo-drug combination in first line of treatment: BP targets may be reached earlier than with monotherapy, both drugs can be given at low doses so that the risk of side effects is minimised, some drug combinations can attenuate the side effects associated with the single agent, patient compliance may be improved by achieving target BP earlier, especially in patients with very high BP and by simplifying treatment and fixed low-dose combinations are available in a single tablet. In patients uncontrolled or with the presence of two or more additional CV risk factors therapy, the fixed combination is the next logical step to monotherapy, and may result in synergistic BP reduction and complementary clinical benefits due to the different modes of action and the additional benefits of the individual drugs. |
