Clinical Medicine Reviews in Vascular Health

The guidelines and consensus documents on hypertension management have emphasized the need for a better arterial hypertension (AH) control, and, thus, have recommended an optimized treatment, which usually requires the combined use of drugs that block different mechanisms responsible for blood pressure (BP) increase. For stage 2 and 3 hypertensives, the association of two drugs is mandatory, and if the BP goal is not attained, the association of a third drug is the preferential option. For high CV risk patients, the current tendency is to block the renin-angiotensin-aldosterone system (RAAS) with an angiotensin-converting-enzyme inhibitor (ACEI) or with an angiotensin II type 1 receptor blocker (ARB) or even with a direct renin inhibitor (DRI), associated with a calcium channel blocker (CCB). When the BP goal is not reached with this type of association, a diuretic compound is the drug to be added. The triple combination of Olmesartan (OM), amlodipine (AM)L, and hydrochlorothiazide (HCTZ) seems to be one of the most adequate choice, due to the complementary mechanisms of action of their agents. This study aimed at reviewing both the rationale for the combined use of drugs for controlling AH and the results of the clinical trials on the triple association of OM, AML, and HCTZ.