Combining drug therapy for BP

Combining low doses of two or three antihypertensives from different drug classes can significantly lower blood pressure and minimise adverse effects, compared with increasing the dose of a single drug.1-3 However, before prescribing combination therapy, consider possible adverse effects, coexisting conditions that may affect drug choice, interactions with other medications, and the potential for patient confusion and medication error.

Ideally, establish the effective dose of, and patient response to, each individual drug in the combination. Ensure that the available doses allow adequate titration of the component medications. 

Assess patient response to any medication change every six weeks, or more frequently if appropriate.1 

Once stabilised, review every three months or so for one year, and every six months thereafter if blood pressure remains stable.1 

Beware of the ‘triple whammy’: an ACE inhibitor or