Other classes of antihypertensive have compelling contraindications when conditions

such as asthma (unselective β-blockers), pregnancy, hyperkalemia, PCI-32765 ic50 or bilateral renal artery stenosis (ACE inhibitor/ARB) are present [2]. Prescribers should also consider potential AE Baf-A1 cell line profiles when considering antihypertensive treatment, as these can be strong deterrents to patient adherence [49]. CCBs may also be a preferred drug class in many antihypertensive combination strategies (with ACE inhibitors, ARBs, and diuretics) [2]. Combination of nifedipine GITS (gastrointestinal therapeutic system) with either losartan or lisinopril has demonstrated greater BP lowering than https://www.selleckchem.com/products/VX-680(MK-0457).html with either agent alone [50, 51]; in the mulTicenter study evALuating the Efficacy of Nifedipine GITS-Telmisartan combination in BP control and beyond (TALENT), initial combination therapy provided greater and earlier (from 2 weeks) 24-h BP control vs. monotherapy [52]. The Avoiding Cardiovascular events through Combination therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) study was the only large trial to directly compare RAS blockade in combination

with either a CCB or a diuretic, and demonstrated the benefit of an amlodipine-benazepril combination over a hydrochlorothiazide (HCTZ)-benazepril combination for reducing CV events in high-risk patients with hypertension [48]. However, the combination of RAS blockade with a diuretic has shown beneficial

outcomes in particular subgroups of patients, such as those with congestive Dichloromethane dehalogenase heart failure [53], and an ACE inhibitor/diuretic combination appears to demonstrate a particular additive efficacy in Black patients [54]. In the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study, an ARB/diuretic combination (losartan/HCTZ) showed significantly better reductions in CV morbidity and mortality for similar BP reduction, largely attributable to superior stroke prevention [55]. The Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) showed lower visit-to-visit BP variability with a CCB-ACE inhibitor combination (amlodipine based) vs. a β-blocker-diuretic combination (atenolol based), and the CCB-ACE inhibitor combination was associated with a 34 % reduction in new-onset diabetes [56]. Dual RAS blockade is no longer recommended owing to concerns regarding renal damage and an increased incidence of stroke [57, 58]. International guidelines vary in their recommendations toward initiating monotherapy vs. combination therapy (Table 3).