Aspectos prácticos de la combinación de 3 fármacos antihipertensivos a dosis fijas

Recent studies performed in Spain show an increase in hypertension (HT) control associated with greater use of combination therapy. As indicated by all clinical trials analyzing morbidity and mortality, antihypertensive combinations are essential to achieve blood pressure targets and reduce the cardiovascular complications of HT. However, in clinical practice, blood pressure values are still far from acceptable. Two of the most widely recognized barriers to acceptable control are lack of patient adherence and the conservative attitudes of some physicians (inertia). Triple-drug fixed-dose combinations for the treatment of HT can help to overcome these barriers as, among other reasons, these regimens simplify the treatment. Some studies, notably the TRINITY trial, have shown that the combination of olmesartan, amlopidine and hydrochlorothiazide can achieve blood pressure control rates of 80%. Moreover, by including angiotensin II receptor antagonists, the triple combinations currently available in Spain have the advantage of reducing the incidence of clinical adverse effects (the peripheral edema associated with calcium channel blockers) and metabolic adverse effects (thiazide hypokalemia), thus increasing tolerability. Possible candidates for receiving fixed-dose triple-drug combination therapy are patients poorly controlled with two drugs or those with blood pressure values on target receiving triple therapy, with a fixed combination of two and a free combination of a third.