En español | A new study challenges the traditional method of prescribing blood pressure medication — to start with one drug and add others if the first isn't enough — and some experts are calling for a change in guidelines that could help doctors with the delicate and often frustrating dilemma of getting blood pressure meds right.
But leaving blood pressure uncontrolled in the initial phases of treatment can leave patients vulnerable to strokes and heart attacks, says Bakris. And in the new trial, starting on combination therapy produced no more untoward effects — such as swelling in the legs — than introducing medicines sequentially. "If combination therapy gets you to your blood pressure goal faster, safely, then why not do it?" he says.
Physicians have been reluctant to adopt combination therapy for hypertension, partly, says Bakris, because of a lack of training in the area. Indeed, according to William Cushman, M.D., a leading hypertension researcher at the University of Tennessee College of Medicine in Memphis who also worked on the hypertension guidelines panel, a key reason to push for early attainment of blood pressure goals is the reality of "clinical inertia."
Blood pressure medications can be notoriously tricky to get right, and, over many months and repeated physician visits, "either the doctor or the patient bails out," says Cushman, and optimal blood pressure control is never achieved.
Although the study looked at two specific drugs, Bakris says the research speaks to the value of "combination therapy in general" rather than to the superiority of particular drugs. In fact, the ASH statement lists as "preferred" four combinations of established drug classes. Insurers often prefer these combinations, many of which are available as generics, including some single-pill combinations.
Katharine Greider lives in New York and writes about health and medicine.