Document Detail

Combination therapy with ACE inhibitors/angiotensin II receptor antagonists and diuretics in hypertension.
MedLine Citation:
PMID:  15030296     Owner:  NLM     Status:  MEDLINE    
Essential hypertension is a very heterogeneous disease and different pressor mechanisms might interact to increase blood pressure. It is therefore not surprising that antihypertensive drugs, given as monotherapy, normalize blood pressure in only a fraction of hypertensive patients. This is, for instance, the case for diuretics, angiotensin converting enzyme (ACE) inhibitors and angiotensin II (AT1) receptor antagonists administered as single agents. The rationale for combining antihypertensive agents relates in part to the concept that the blood pressure-lowering effect may be enhanced when two classes are coadministered. Also, combination therapy serves to counteract counter-regulatory mechanisms that are triggered whenever pharmacologic intervention is initiated and that act to limit the efficacy of the antihypertensive medication. For example, the compensatory rise in renin secretion induced by sodium depletion may become the predominant factor sustaining high blood pressure. Simultaneous blockade of the renin-angiotensin system, with either an ACE inhibitor or an AT1-receptor blocker, makes this compensatory hyper-reninemia ineffective and allows maximum benefit from sodium depletion. The combination of a blocker of the renin-angiotensin system and a low dose of a diuretic increases the effectiveness, but not at the expense of tolerability compared with the individual components administered alone. Fixed-dose combinations containing an ACE inhibitor or an AT1-receptor blocker and a diuretic are therefore likely to become increasingly used not only as second-line therapy but also as first-line treatment.
Bernard Waeber
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Expert review of cardiovascular therapy     Volume:  1     ISSN:  1477-9072     ISO Abbreviation:  Expert Rev Cardiovasc Ther     Publication Date:  2003 May 
Date Detail:
Created Date:  2004-04-02     Completed Date:  2004-05-07     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  101182328     Medline TA:  Expert Rev Cardiovasc Ther     Country:  England    
Other Details:
Languages:  eng     Pagination:  43-50     Citation Subset:  IM    
University Hospital, Division of Pathophysiology, Lausanne, Switzerland.
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MeSH Terms
Angiotensin-Converting Enzyme Inhibitors / administration & dosage
Antihypertensive Agents / administration & dosage
Blood Pressure / drug effects
Chemistry, Pharmaceutical
Drug Therapy, Combination
Hypertension / drug therapy*
Randomized Controlled Trials as Topic
Receptors, Angiotensin / antagonists & inhibitors
Sodium Chloride Symporter Inhibitors / administration & dosage
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 0/Antihypertensive Agents; 0/Benzothiadiazines; 0/Diuretics; 0/Receptors, Angiotensin; 0/Sodium Chloride Symporter Inhibitors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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