Combination Therapy vs. Monotherapy
Combination therapy, which uses regimens involving fixed-dose combinations (FDC) or regimens that have ‘drugs added sequentially one after other’, is now favored by the medical fraternity to treat hypertension.
Combination therapy is better than monotherapy because -
- Drugs are available in a convenient dosing format; and
- Drugs cause fewer side effects because of the lower dose of individual component.
In a recent paper published in the journal Hypertension, researcher Brent Egan from the Department of Medicine, Medical University of South Carolina, and colleagues showed that ‘Initial therapy with single-pill combinations provided better hypertension control in the first year than free combinations or monotherapy with benefits in black and white patients’. Other studies have found better cardiovascular outcomes with single-pill combination therapy for hypertension.
However, Dr Alan H Gradman, from Western Pennsylvania Hospital, Pittsburgh, pointed out that even though single pill combination therapy could be an attractive option that would improve compliance, the cost factor could be a critical issue for many patients since most of these pills are branded combinations and are often more expensive.
American Society of Hypertension (ASH) recommended the following drug combinations in hypertension -
Drug combinations in hypertension: Recommendations of ASH
|Preferred 2-drug combinations||Acceptable 2-drug combinations||Unacceptable 2-drug combinations|
|ACE inhibitor/diuretic*||Beta-blocker/diuretic*||ACE inhibitor/ARB|
|ARB/diuretic*||CCB/diuretic||ACE inhibitor/beta blocker|
|ACE inhibitor/CCB*||Renin inhibitor/diuretic||ARB/beta blocker|
|ARB/CCB*||Thiazide diuretic/potassium-sparing diuretic||CCB (nonhydropyridine)/beta blocker|
|Centrally acting agent/beta blocker|
*Single-pill combinations available in the US