A number of clinical studies since long has shown the advantage of giving multiple drugs and Paul Ridker, Professor of Medicine; Brigham and Women's Hospital and Harward Medical School, Boston told United Press International that blood pressure can be brought to normal range better by using multiple drugs than using a single drug first and adding another drug later.
Keeping the blood pressure in the normal range decreases the risk of CVA, MI and nephropathy.
At the annual meeting of the American Society of Hypertension in New York, Ridker informed the importance of Valsartan (Diovan), an angiotensin receptor blocker in people with hypertension. Further a combination of Valsartan with a standard diuretic can bring the blood pressure further below.
Almost 50% of the patients on this combination therapy could achieve their blood pressure in the normal range compared to 32% on single drug, who could not get their levels to the desired range.
Joel Neutel, Medical director of the Orange County Heart Institute and Research Center, Orange, Calif. Reports from another study that combination of Amlodipine (Norvsc) and ACE inhibitor Quinapril (Accupril) / angiotensin receptor blocker losartan (Cozaar) helps in bringing the blood presuure to normal range than any of these drugs used single.
His study highlighted the importance of multiple drug therapy to monotherapy in diabetics with hypertension.
According to Neutel's study, 27.5% of the difficult to treat hypertensive patients with blood pressure targets lower than those without diabetes could reach a target of 130/80 mm Hg compared to 12.5% on monotherapy.
Neutel in a press conference to UPI highlighted the importance of combination therapy to reach the target blood pressure. In patients needing 3-4 drugs and he would prefer a diuretic as a third drug of choice.
In two other studies, doctors used the combination of two drugs, one to lower blood pressure and another to lower cholesterol. 50% 0f people with hypertension also have high blood cholesterol, another risk factor for the heart, according to John Kostis, Professor of medicine and pharmacology at the University of Medicine and Dentistry of New Jersey, New Brunswick.
Literature in TNT (Treating to New Targets) states that LDL cholesterol levels and blood pressure were low in people with lower cardiovascular problems (MI, CVA, need for relieving angina) said John Kostis.
He treated his patients with a combination of Norvasc and Lipitor (Atorvastatin).
In a study on African Americans, John Flack professor of medicine at Wayne State University, Detroit, used similar drugs. He used Caduet (combination of Norvasc and Lipitor) in people with mild / moderate / high hypertension.
48.3% patients could achieve normal blood pressure and normal cholesterol levels, 73.7 % could reach normal cholesterol levels and 56.8% could reach normal blood pressure levels on Cauduet.
Jan Basile, professor of medicine at the Medical University of South Carolina, Charleston stressed the need to review these studies and the commencement of combination therapy for the patients.
According to Flack, some doctors practice monotherapy and do not add/change the drug even in patients who continue to have high blood pressure.
He further stressed the need to get over physician / therapeutic inertia which is the biggest problem in cardiovascular management in tough to treat groups (diabetics and African Americans).