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What is the incremental effect of combination therapy using blood pressure (BP)–lowering drugs from 2 classes compared with monotherapy for reducing BP?
Included studies compared combinations of BP-lowering drugs from 2 of 4 classes (thiazides, β blockers [BBs], angiotensin-converting enzyme inhibitors [ACE-Is], and calcium-channel blockers [CCBs]) with each drug alone and with placebo and were ⩾2 weeks in duration. Trials with a non-randomised order of treatment and placebo were excluded. Outcome was mean placebo-subtracted systolic BP reduction (difference in BP reduction between treatment and placebo groups).
Medline, EMBASE/Excerpta Medica, and Cochrane Library (1966–Mar 2008); websites of industry and US Food and Drug Administration; and reference lists were searched for factorial, randomised placebo …
Source of funding: no external funding. Dr N Wald and Dr M Law hold patents (EU1272220 and GB2361186) for a combination ‘polypill’ for prevention of cardiovascular disease. Dr D Wald also has an interest in its development.