Overcoming clinical inertia to achieve blood pressure goals: the role of fixed-dose combination therapy

The treatment of hypertension should cause blood pressure (BP) changes that reduce the long-term risks of cardiovascular morbidity and mortality. There are considerable clinical benefits to be gained by promptly treating patients to recognized BP goals, particularly for those at high risk. This may be achieved by the use of combination therapy as first-line treatment. However, despite widely acknowledged therapeutic guidelines, there are significant gaps between current treatment recommendations and their implementation in clinical practice. One important explanation for inadequate treatment and subsequent poor BP control is clinical inertia. Undertreatment and clinical inertia may sometimes be mistaken for treatment-resistant hypertension, as is often the case in specific patient populations whose disease is often considered a challenge to treat because of a greater risk of cardiovascular complications (e.g. Blacks, obese patients, and those with diabetes). The availability of fixed-dose drug combinations may address some of the common misconceptions thought to promote clinical inertia. Few studies have specifically focused on subpopulations with difficult-to-treat hypertension that is uncontrolled on monotherapies. One example is an ongoing 20-week, multicenter, prospective, blinded endpoint, dose-titration, treat-to-goal study evaluating the efficacy and safety of initial fixed-dose combination therapy with amlodipine/olmesartan medoxomil, and further up-titration with hydrochlorothiazide, in patients with hypertension who are uncontrolled on antihypertensive monotherapy. This study may demonstrate the benefits of treating patients with hypertension to goal using initial fixed-dose combination therapy, even in patients considered to be at a higher risk of cardiovascular complications.