Healthcare benefits of very-low-dose combination treatment used in the management of hypertension

There are several classes of effective pharmacological agents available for the treatment of hypertension. However, rates of successful blood pressure control remain low among treated patients, while antihypertensive medication represents a large and increasing proportion of healthcare expenditure in many countries. Several influential pharmacoeconomic analyses have confirmed the costeffectiveness of conventional antihypertensive treatments, usually involving monotherapy using diuretics or beta-blockers, compared with alternative strategies. Recent research has shown that a considerable proportion of the total cost of antihypertensive treatment in general practice is attributable to factors such as inadequate blood pressure control, poor compliance with treatment, discontinuation of treatment, and switching between treatments. These factors are generally less influential in well-supervised clinical trials, and have not been fully incorporated into most economic studies. Some novel strategies, particularly the use of low-dose combinations of antihypertensive agents as first-line therapy, may offer advantages in terms of efficacy, reduced side effects, and improved compliance with treatment; these advantages would be predicted to result in improved cost-effectiveness. There is therefore a need for comprehensive pharmacoeconomic analyses of novel strategies, taking these additional factors into account. Until such studies are available, the wider use of low-dose combination treatments and other novel strategies should not be held back on the basis of findings of earlier economic studies that have not included all relevant considerations.