Combined drugs as first line treatment of arterial hypertension

Arterial hypertension is a major worldwide public health challenge. It has been identified as a major risk factor of mortality and cardiovascular disease. Numerous of surveys shows that blood pressure control is limited with traditional first line-therapeutic strategies, such as monotherapy. Studies clearly show that BP control (≤40/90 mmHg) achieved within the first six months directly translates into significant reduction in cardiovascular events and all-cause mortality. These results give new insights into the clinical importance of achieving BP control in the short term, highlighting the crucial importance of choosing the best strategy right from the start. By using a combination of two drugs with different mechanisms of action, it is more likely that BP control and protection against CV complications will be more efficient. Moreover, fixed dose combination ensures better side-effect profile than monotherapy. Recent guidelines, ESH/ESC as well as PSH, recommend a fixed low-dose combination of two drugs as the first line treatment. Noliprel (perindopril 2 mg/indapamide 0,625 mg) is the only fixed-dose combination recommended as the first line treatment of hypertension which is available in Poland. In this article the fixed-dose combination of perindopril/indapamide has been shown in controlled trials to be more effective than other conventional first-line strategies in blood pressure control. Its clinical efficacy and prevention of end-organ damage in hypertension suggest that such a combination could offer further clinical benefits for diabetic patients with or without hypertension. The results of the ADVANCE study which could create the new therapeutic indication for fixed-dose first line combination perindopril/indapamide are expected in 2007.