Combination treatment in antihypertensive drug trials

Intermediate versus hard end points in clinical trials on hypertension

The main features of randomized clinical trials performed in the field of hypertension treatment are reviewed, based either on the evaluation of clinical events or on the assessment of surrogate outcome measures. The advantages, limitations, and clinical relevance of each approach are highlighted.

Present and future role of combination treatment in hypertension

Both in clinical practice and in drug trials, combination treatment of hypertension plays a fundamental role. This article reviews the features that make combined therapy with two drugs valuable, i.e., additive antihypertensive efficacy, different mechanisms of action, and reciprocal side-effect minimization. Also examined are the advantages and disadvantages of a fixed combination, emphasizing that a major advantage is simplification of the treatment schedule. This is clinically relevant because complexity of treatment negatively affects patient compliance, which in hypertensive patients is poor, leading to poor long-term blood pressure control in the hypertensive fraction of the population.