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Introduction

 

Hypertension is a pervasive and growing threat to global health. The number of adults with hypertension has nearly doubled from 442 million to 874 million worldwide in the past 25 years.1 Among those with hypertension, many take antihypertensive drugs from multiple classes (such as thiazide-type diuretics and angiotensin converting enzyme (ACE) inhibitors) to control their blood pressure and reduce cardiovascular risk.2 Although the addition of a second (or third) class of antihypertensive drug to a patient’s hypertension treatment regimen is done routinely in clinical practice, the incremental benefits and risks of each additional drug class remain controversial. It is commonly believed that the addition of a new drug class to a patient’s regimen will result in progressively smaller reductions in blood pressure while increasing the risk of adverse events.345 Because of physiologic limitations or drug-drug interactions, escalation of the number of antihypertensive drugs has been postulated to produce diminishing benefits and increasing harms.6 Such concerns are particularly pronounced for older patients78 or those for whom some drugs might prove less effective, such as patients with resistant hypertension91011 or black patients.1213 Others have argued that adding a drug from a new class that targets a distinct and complementary mechanism, however, could reduce blood pressure at lower doses of each drug, improving therapeutic benefit and lowering side effects.1415

 

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5542 (Published 22 December 2017) Cite this as: BMJ 2017;359:j5542



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