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Review: lower dose combination antihypertensive therapy is preferable to standard dose single drug therapy

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 Q What is the safety and efficacy of different doses and combinations of 5 main categories of blood pressure (BP) lowering drugs?

Clinical impact ratings GP/FP/Primary care ★★★★★★☆ Internal medicine ★★★★★★☆


Embedded ImageData sources:

Medline (1966–2000; extended to 2001 for studies of angiotensin II receptor blockers [ARBs]), Cochrane Library, and Web of Science database; bibliographies of relevant studies; and pharmaceutical companies.

Embedded ImageStudy selection and assessment:

randomised, double blind, placebo controlled trials that examined change in BP in relation to a specified fixed dose of any thiazide, β blocker, angiotensin converting enzyme (ACE) inhibitor, ARB, or calcium channel blocker. Studies were excluded if duration was <2 weeks; most participants were black; or patients had heart failure, acute myocardial infarction, or other cardiovascular disorders.

Embedded ImageOutcomes:

BP reductions and adverse effects.


354 trials (median duration 4 wk) met the selection criteria. The trials included 791 treatment groups (219 in crossover and 572 in parallel group …

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  • Abstract and commentary also appear in ACP Journal Club.

  • For correspondence: Professor M R Law, University of London, London, UK.

  • Source of funding: no external funding.