Combined antihypertensive drug regimen

  The Chinese Guidelines for the Prevention and Treatment of Hypertension (Primary Edition 2009) have recommended the first four combinations of 1) CCB and ACEI or ARB; 2) ACEI or ARB and low-dose diuretics; 3) CCB (dihydropyridines) and low-dose beta-blockers; 4) CCB and low-dose diuretics; 5) low-dose diuretics and low-dose beta-blockers; 6) alpha-blockers and beta-blockers. blockers; 6) α-blockers and β-blockers. In the new 2010 revision of the Chinese guidelines for the prevention and treatment of hypertension, it is considered that hypertension is a progressive “cardiovascular syndrome” characterized by a continuous increase in arterial blood pressure, often accompanied by other risk factors, target organ damage or clinical disorders, and requires comprehensive intervention. The basic principles of antihypertensive therapy include an initial small effective therapeutic dose and a gradual increase in the dose; long-acting drugs with a continuous 24-hour antihypertensive effect are recommended for once-a-day administration to effectively control nighttime blood pressure and morning peak blood pressure and more effectively prevent cardiovascular complications; combination therapy is often required for grade 2 or higher hypertension to achieve target blood pressure. For patients with blood pressure ≥160/100mmHg or above medium risk, the combination of two drugs in small doses can be used at the beginning, or with small fixed compound preparations; according to the specific situation and tolerance of the patient and personal wishes or long-term tolerance, choose the appropriate antihypertensive drugs for the patient.  The current emphasis on initiating combination therapy for high-risk patients with blood pressure ≥ 160/100 mmHg, or 20/10 mmHg above target blood pressure, is as follows.  Priority is given to the following regimens Step 1: ACEI/ARB plus dihydropyridine calcium channel blocker (A+C); ACEI/ARB plus thiazide diuretic (A+D); dihydropyridine calcium channel blocker plus thiazide diuretic (C+D); dihydropyridine calcium channel blocker plus beta-blocker (C+B); low-dose fixed-combination formulation.  Step 2: If blood pressure is not achieved with the above treatment, start triple antihypertensive therapy with ACEI/ARB plus dihydropyridine calcium channel blocker plus thiazide diuretic; or ACEI/ARB plus dihydropyridine calcium channel blocker plus beta-blocker; or ACEI/ARB plus thiazide diuretic plus alpha-blocker.  The following regimens may be considered or generally recommended Diuretics + beta-blockers; alpha-blockers + beta-blockers; dihydropyridine calcium channel blockers + potassium-protective diuretics; thiazide diuretics + potassium-protective diuretics.  Not routinely recommended ACEI + β-blocker; ARB + β-blocker; ACEI + ARB.