Fixed-dose combination and chronic kidney disease progression: which is the best?

PURPOSE OF REVIEW: Use of combination therapy whether fixed dose or separate pill combinations is becoming more prevalent. Physicians are not routinely trained in using combinations of different antihypertensive medicines.

RECENT FINDINGS: Recent outcome trials as well as smaller studies document that meaningful combinations of pharmacologically additive agents help achieve blood pressure (BP) goals faster and reduce outcomes. Clinical trials demonstrate that drugs interfering with the renin-angiotensin system, that is, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, combined with either calcium antagonists or thiazide-like diuretics and used as first-line antihypertensive therapy in patients whose BP is more than 20/10 mmHg above goal achieve BP goal faster than sequential monotherapy. Additionally, certain combinations may provide better cardiovascular outcomes than other combinations. Lastly, combination therapy has a clear role in helping to reduce cardiovascular and renal risk, when used.

SUMMARY: This review provides an update of current evidence regarding the associations of BP control with use of combination antihypertensive therapy to achieve BP goals. A rationale for initial single pill and fixed-dose combination therapy is reviewed. Only one trial with cardiovascular outcome has been performed using a fixed-dose combination and this revealed differences from other trials, including the greatest number of people achieving goal BP and difference in outcomes based on combination used.