Combination therapy for hypertension management: insights from the Indian experts

Authors

  • Peeyush Jain Department of Preventive Cardiology, Fortis-Escorts, New Delhi, India
  • S. C. Jha Department of Medicine, Hospital Road, Sitamarhi, Bihar, India

DOI:

https://doi.org/10.18203/issn.2454-2156.IntJSciRep20241317

Keywords:

HTN, Combination therapy, CVDs, Cardiovascular risk, Personalized medicine, Telmisartan, Amlodipine

Abstract

Cardiovascular diseases (CVDs) pose a significant global health challenge, with India bearing a disproportionate burden of CVD-related morbidity and mortality. Hypertension (HTN) is a major risk factor for CVDs, affecting nearly 30% of the Indian population. Achieving target blood pressure (BP) levels is crucial for reducing cardiovascular risk, necessitating aggressive antihypertensive therapy. Combination therapy has emerged as a cornerstone in HTN management, especially in high-risk patients. This review delves into the literature and perspectives of Indian cardiologists on combination therapy for HTN management. Despite the efficacy of contemporary antihypertensive medications, a substantial proportion of patients fail to reach target BP levels with monotherapy. Combination therapy offers synergistic effects, addressing multiple pathways involved in HTN pathogenesis. Recent guidelines recommend initiating treatment with two-drug combinations, transitioning to three-drug combinations in resistant cases. Combination therapy not only enhances BP control but also reduces the risk of cardiovascular events and mortality compared to monotherapy. Optimal management of HTN requires personalized approaches, considering individual patient profiles and comorbidities such as coronary artery disease (CAD), diabetes mellitus (DM), dyslipidemia, and heart failure (HF). In such cases, combination therapy plays a pivotal role in mitigating cardiovascular risks. ARB/CCB combination therapy, particularly telmisartan/amlodipine, demonstrates significant efficacy and tolerability across various patient populations, including those with metabolic risk factors and renal impairment. Expert recommendations highlight the importance of individualized therapy, patient education, early diagnosis, and initiation with dual therapy in India. Strategies to improve medication adherence and compliance, such as single-pill double or triple combinations, are emphasized. Moreover, awareness of newer treatment options and contactless diagnostic instruments is crucial for optimizing HTN management. In conclusion, combination therapy stands as a cornerstone in HTN management, offering enhanced efficacy, tolerability, and cardiovascular protection. Tailored approaches guided by expert recommendations are essential to address the growing burden of HTN and reduce the socioeconomic impact of CVDs in India.

Metrics

Metrics Loading ...

References

Abdullakutty J, Mazumder C. Management of hypertension across the cardiovascular-renal continuum. Int J Cardiol Sci. 2023;5(1):37-43.

Kalra A, Jose AP, Prabhakaran P, Kumar A, Agrawal A, Roy A, et al. The burgeoning cardiovascular disease epidemic in Indians-perspectives on contextual factors and potential solutions. Lancet Reg Health Southeast Asia. 2023;12:100156.

Ramakrishnan S, Zachariah G, Gupta K, Shivkumar Rao J, Mohanan PP, Venugopal K, et al. Prevalence of hypertension among Indian adults: Results from the great India blood pressure survey. Indian Heart J. 2019;71(4):309-313.

McInnes GT. How important is optimal blood pressure control? Clin Therapeutics. 2004;26:A3-A11.

Guerrero-García C, Rubio-Guerra AF. Combination therapy in the treatment of hypertension. Drugs Context. 2018;7:212531.

Paril S, Acelajado MC, Bakris GL, Berlowitz DR, Cífková R, Dominiczak AF, et al. Hypertension. Nat Rev Dis Primers. 2018;4:18014.

Volpe M, Gallo G, Tocci G. Is early and fast blood pressure control important in hypertension management? Int J Cardiol. 2018;254:328-32.

Mancia G, Kreutz R, Brunström M, Burnier M, Grassi G, Januszewicz A, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023;41(12):1874-2071.

Mehta AK. Managing Hypertension in Coronary Artery Disease. Hypertens. 2020;6(2):87-93.

Miao H, Zou C, Yang S, Chia YC, Van Huynh M, Sogunuru GP, et al. Targets and management of hypertension in heart failure: focusing on the stages of heart failure. J Clin Hypertens (Greenwich). 2022;24(9):1218-25.

Lu S, Bao MY, Miao SM, Zhang X, Jia QQ, Jing SQ, et al. Prevalence of hypertension, diabetes, and dyslipidemia, and their additive effects on myocardial infarction and stroke: a cross-sectional study in Nanjing, China. Ann Transl Med. 2019;7(18):436.

Garg R. Individualization of hypertension treatment: an expert review. Int J Adv Med. 2023;10(8):647-52.

Vlachopoulos C, Ioakeimidis N. Practical solutions for hypertensive patients with dyslipidemia. Artery Res. 2017;18:49-54.

Kumar V, Agarwal S, Saboo B, Makkar B. RSSDI Guidelines for the management of hypertension in patients with diabetes mellitus. Int J Diabetes Dev Ctries. 2022;42(1):1-30.

Smith DK, Lennon RP, Carlsgaard PB. Managing Hypertension Using Combination Therapy. Am Fam Physician. 2020;101(6):341-9.

Oparil S, Weber M. Angiotensin receptor blocker and dihydropyridine calcium channel blocker combinations: an emerging strategy in hypertension therapy. Postgrad Med. 2009;121(2):25-39.

Ahrens K, Bramlage P. Importance of a fixed combination of telmisartan and amlodipine for the treatment of hypertension. Drugs Today (Barc). 2010;46(5):339-50.

Ley L, Schumacher H. Telmisartan plus amlodipine single-pill combination for the management of hypertensive patients with a metabolic risk profile (added-risk patients). Curr Med Res Opin. 2013;29(1):41-53.

Sharma AM, Bakris G, Neutel JM, Littlejohn TW, Kobe M, Ting N, et al. Single-pill combination of telmisartan/ amlodipine versus amlodipine monotherapy in diabetic hypertensive patients: an 8-week randomized, parallel-group, double-blind trial. Clin Ther. 2012;34(3):537-51.

Mallat SG. What is a preferred angiotensin II receptor blocker-based combination therapy for blood pressure control in hypertensive patients with diabetic and non-diabetic renal impairment? Cardiovasc Diabetol. 2012;11:32.

Rajadhyaksha GC, Reddy H, Singh AK, Oomman A, Adhyapak SM. The Indian registry on current patient profiles and treatment trends in hypertension (RECORD): One year interim analysis. Indian J Med Res. 2023;158(3):244-55.

Downloads

Published

2024-05-23

Issue

Section

Review Articles