Combinations of Antihypertensive Drugs

Combinations of antihypertensive drugs. The combination of an ACE inhibitor or an angiotensin receptor blocker (ARB) with a calcium-channel blocker or/and with a thiazide diuretic is primarily recommended. Beta blockers may be used in combination therapy when there are other indications for it (symptomatic coronary artery disease, arrhythmias, cardiac failure). The combination of an ACE inhibitor or an ARB with a beta blocker is not optimal as regards lowering of blood pressure (black dashed line), but even this combination may be used if there are other indications for it (e.g. coronary artery disease as an indication for beta blockers).

The combination of a beta blocker and a diuretic (yellow dashed line) should be avoided as the first-line medication in a patient with metabolic syndrome or with an increased risk of developing diabetes. Furthermore, it is possible to use the combination of a calcium-channel blocker with dihydropyridine structure and a diuretic or of a dihydropyridine calcium-channel blocker and a beta-blocker in order to enhance the blood pressure-lowering effect (black solid line). Combining of a beta blocker with verapamil or diltiazem should be avoided due to the associated risk of bradycardia and cardiac conduction disturbances (red dashed and blocked line).

Picture: Finnish Current Care Guidelines