The role of combination antihypertensive therapy and the progression of renal disease hypertension: Looking toward the next millennium

The importance of the level to which blood pressure is reduced becomes increasingly important when one considers preservation of renal function. It is clear that three major subsets of patients emerge as requiring levels of blood pressure control of < 130/85 mm Hg to preserve renal function. Such individuals include black Americans, those with diabetic nephropathy, and those with renal insufficiency or ≥ 1 g of proteinuria. It is clearly important to achieve such levels of blood pressure control in these high-risk individuals. It is also clear that single-agent therapy will never achieve these levels of blood pressure control. Therefore, multiple antihypertensive agents will be required to achieve such a goal. With increasing numbers of medications, however, there is also, unfortunately, a decrease in compliance. Therefore, fixed-dose combinations emerge as playing a major part both in achieving a level of blood pressure control as well as maintaining levels of compliance. Certain types of angiotensin-converting enzyme inhibitors, as well as calcium channel antagonist combinations, however, appear to have better overall effects than others do. These and related data are reviewed in this paper.