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(Hypertension. 2009;54:19.)
© 2009 American Heart Association, Inc.

Editorial Commentaries

Triple Fixed-Dose Combination Therapy

Back to the Past

Henry R. Black

From the New York University School of Medicine, Center for the Prevention of Cardiovascular Disease, New York.

Correspondence to Henry R. Black, Skirball 9U, 530 First Ave, New York, NY 10016. E-mail hrbmd63@gmail.com

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In this issue of Hypertension, Calhoun et al¹ report on a large (n=2271), short (9 weeks of treatment after 4 weeks of washout and placebo), well-designed, properly controlled, international randomized trial of a triple combination of a diuretic (D; hydrochlorothiazide [HCTZ]), a dihydropyridine calcium channel blocker (DHPCCB; amlodipine [A]), and an angiotensin reception blocker (ARB; valsartan [V]) in volunteers who had a mean sitting (MS) diastolic blood pressure (BP; MSDBP) of 100 mm Hg. The results support what all would have anticipated: the use of 3 antihypertensive medications with different mechanisms of action would lead to a greater drop in BP than would combinations of any 2 of the 3 drugs given as 2-drug combinations. In fact, any other result would have been news, because combination therapy has many obvious advantages and some disadvantages compared with single-drug therapy (Tables 1 to 3).

View this table:   Table 1. Advantages of Multidrug Therapy in Hypertension

View this table:   Table 2. Advantages of a Fixed-Dose Combination as Antihypertensive Therapy

View this table:   Table 3. Disadvantages of a Fixed-Dose Combination as Antihypertensive Therapy

The main result was that the triple combination reduced MS BP by 40/25 mm Hg, whereas the 2-drug combination of the ARB/D achieved a 32/20-mm Hg reduction, and the ARB/DHPCCB combination lowered MSBP by 34/22 mm Hg, whereas the DHPCCB/D combination dropped MSBP by 31/19 mm Hg. All of these differences were highly statistically significant, thanks in part to the large sample size. More important, the differences between these regimens, a minimum of 8/5 mm Hg for . . . [Full Text of this Article]

Related Article:

Triple Antihypertensive Therapy With Amlodipine, Valsartan, and Hydrochlorothiazide: A Randomized Clinical Trial

David A. Calhoun, Yves Lacourcière, Yann Tong Chiang, and Robert D. Glazer
Hypertension 2009 54: 32-39. [Abstract] [Full Text] [PDF]