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I Brazilian Position Paper on Antihypertensive Drug Combination

2014; Sociedade Brasileira de Cardiologia (SBC); Linguagem: Inglês

10.5935/abc.20140023

1678-4170

Rui Póvoa, Weimar Kunz Sebba Barroso, Andréa Araújo Brandão, Paulo César Brandão Veiga Jardim, Oswaldo Barroso, Oswaldo Passarelli, João Roberto Gemelli, Audes D. M. Feitosa, Thiago Veiga Jardim, Sérgio Baiocchi Carneiro, Celso Amodeo, Osni Moreira Filho, Armando da Rocha Nogueira, Nelson Siqueira de Morais, Luiz César Nazário Scala, Carolina Gonzaga, Dilma do Socorro Moraes de Souza, Annelise Machado Gomes de Paiva, Marcus Vinícius Bolívar Malachias, Décio Mion, Marco Antônio Mota Gomes, Eduardo Costa Duarte Barbosa, Márcio Gonçalves de Sousa, Henrique Tria Bianco, Francisco Antônio Helfenstein Fonseca, Marcio Kalil, Roberto Dischinger Miranda, Carlos André Uehara, Antônio Felipe Sanjuliani,

Blood Pressure and Hypertension Studies

Arterial hypertension (AH) is a highly prevalent disease, and is a major cardiovascular (CV) risk factor1; therefore, achieving blood pressure (BP) control goals as soon as possible is paramount to reduce that risk2. That means that approximately 70% of hypertensive individuals will need antihypertensive drug combination3, and up to 30% of hypertensive individuals are estimated to use four or more drugs to achieve BP control4. Thus, drug combination is currently described as an important strategy to manage AH, providing effective and safe BP reduction. Drug choice is based on effective BP reduction and CV outcomes. Despite the existence of a significant number of drugs to treat AH, their control rates are still very low, contributing to the high CV morbidity and mortality rates observed in Brazil and worldwide1,2. According to the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) and the Hypertension Optimal Treatment (HOT) Study, only 26% and 33% of the patients, respectively, could control their BP with monotherapy, while in the Losartan Intervention for Endpoints Reduction (LIFE) Study, 90% of the patients needed combined therapy for that purpose3 . Drug combination is mainly aimed at increasing antihypertensive efficacy, with fewer adverse events. It is worth noting the importance of considering therapy adherence. The pathophysiology of AH involves multiple factors and mechanisms, making its control difficult when only one drug is used, because counterregulatory mechanisms that attenuate the antihypertensive effect of the drug can occur. The association of drugs with different mechanisms of action has a greater impact on BP reduction as long as there is pharmacokinetic compatibility and no disparity of effects and properties3-5. Thus, the choice of the drugs to be combined should contemplate two aspects: synergism of the mechanisms of action and opposition to counterregulatory mechanisms triggered after the beginning of therapy with a certain drug. The desired antihypertensive efficacy is more likely to be achieved by using lower doses of the drugs involved. Thus, fewer adverse events are observed, with no loss of antihypertensive drug potency3-5. Another important aspect is that drugs should be preferably combined in a single galenic presentation, facilitating their administration, and assuring lower cost, with a consequent improvement in treatment adherence2,6.