Is combination therapy better than monotherapy for Hypertension?
Meta-analyses have suggested that, for most antihypertensive drug classes, combining two different classes of drugs at moderate doses is more likely to lower BP than pushing any one drug to its maximum dose.
This also reduces adverse effects. Combining a CCB with an ACE inhibitor, or probably an angiotensin II receptor blocker (ARB), tends to reduce incidence and severity of pedal edema seen with higher-dose CCBs. In the Avoiding Cardiovascular events through COMbination therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial, patients at high risk for cardiovascular events were randomized to a combination of benazepril and amlodipine or a combination of benazepril and hydrochlorothiazide (HCTZ). The combination of benazepril and amlodipine reduced cardiovascular events more than the combination of benazepril and HCTZ.
