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  Česky / Czech version Prakt. Lék., 2007, 87, No. 9, pp. 525-530
 
Combination drug therapy for hypertension 
WIDIMSKÝ J. sr. 

Klinika kardiologie, IKEM Praha Přednosta: prof. MUDr. Josef Kautzner, CSc. Subkatedra kardiologie IPVZ, Praha Přednosta: prof. MUDr. Vladimír Staněk, CSc.
 


Summary:

       A combination of various sorts of antihypertensive drugs offers an additive blood pressure lowering effect and reduces the risk of side effects that are dependent on antihypertensive drug dose. Since hypertension control in the Czech Republic and worldwide is not satisfactory, and a target BP is attained in only 5-30 % of patients, it is necessary to extend the use of combined hypertension treatment. Monotherapy can only help attain a target BP in 10-25 % of patients. Compliance with monotherapy without reaching the target BP puts patients at risk of cerebrovascular and cardiovascular complications. Combined treatment is indicated in: a) all hypertonie patients with a systolic BP that is >0.20 mmHg above target level or diastolic BP that is >10 mmHg higher than the target level, b) patients with diabetes mellitus (target levels are 130/80 mm Hg, c) patients with eritical organ impairment; d) patients with renal or cardiovascular disease (patients with IHD, patients after a cerebrovascular event). Fixed combinations are more comfortable for patients (requiring them to také fewer pills); however their main advantage is that they often reduce the dose of individual anti-hypertensive drugs. The hitherto favou rite double combination of a thiazide diuretic and a beta blocker is not suitable for patients with metabolic syndrome and in patients at risk of diabetes, because it impairs glucose metabolism. Combinations contai ning doses of thiazide diuretic higher than 25 mg are also unsuitable, the optimal dose of hydrochlorothia zide is 12.5mg. Combinations of 2 antihypertensives of the samé sort are inappropriate. A combination of antihypertensive and a hypolipidemic treatment is also very effective. The article offers a survey of suitab le double, triple and quadruple combinations of antihypertensive drugs, and reviews fixed combinations of hypertensive drugs available on the Czech market.

        Key words: treatment of hypertension, fixed combination, indications of combined treatment
       

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