Aktuelle Aspekte der Kombinationstherapie bei Hypertonie

The overwhelming majority of hypertensive patients need two or more antihypertensive agents to normalize blood pressure. According to US and European guidelines, so-called single-pill drug combinations should be employed whenever possible in order to simplify the regimen and increase long-term medication adherence. With respect to dual-drug combinations, the recently revised European (ESC/ESH) guidelines recommend the following options: RAS blocker (ACE inhibitor and angiotensin receptor blocker) or calcium channel blocker (CCB) plus diuretic or RAS blocker plus CCB. In a head-to-head comparison in patients at high cardiovascular risk, the ACCOMPLISH trial has recently shown a prognostic advantage for a RAS blocker plus CCB combination as compared to RAS blocker plus diuretic. Regarding triple-drug combinations, the revised European guidelines give preference to the combination of an ACE inhibitor or angiotensin receptor blocker plus a CCB and diuretic. Refractory hypertension is defined as the failure to achieve normal blood pressure values despite an effectively dosed triple-drug regimen containing a diuretic. In such patients, poor patient compliance and secondary hypertension should be considered before escalating therapy.