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

https://doi.org/10.1136/ebm.9.1.11

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    Law MR, Wald NJ, Morris JK, Jordan RE. Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials. BMJ 2003;326:1427–34.
    OpenUrlAbstract/FREE Full Text

    
 
 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 ★★★★★★☆

    METHODS

    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.

    MAIN RESULTS

    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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    Footnotes

    • Abstract and commentary also appear in ACP Journal Club.

    • For correspondence: Professor M R Law, University of London, London, UK. m.r.lawqmul.ac.uk

    • Source of funding: no external funding.