Do I Increase the Dose or Augment the Antihypertensive Medication?

Hypertension management can get a little overwhelming sometimes since there are so many medications to choose from.  We often use multiple medications with different mechanisms of action to treat hypertension.

If a patient is already on a medication at a moderate or low dose, what should we do if blood pressure remains elevated?  I’m going to give you some ideas to think about here with the advantages and disadvantages of increasing the dose or adding another agent.

Advantages of adding another agent

  • Be able to cover compelling indications
  • Avoid higher doses of each agent which may reduce incidence of dose dependent side effects
  • Targeting different mechanisms of hypertension may help provide a better response

Disadvantages of adding another agent

  • Complicate patient adherence and patient quality of life with more pills (exception here might be combination meds)
  • More side effect profiles to monitor/potential for drug interactions
  • More expense to the patient

What else do you consider when looking at hypertension medications?

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  1. gopinath

    Yes , agree with you. non pharmacological methods like exercise , dietary changes and social habits will do good for a patient. While going for second agent better try on low dose hydrochlorothiazide ( although anti HT agent )will give better qol in HT patients in comparable patients. If it fails one can go more than 2 drug combi…Regards Gopinath k vinayakam

  2. Michael James Ashmore

    Great small cohort study recently in Lancet using very low dose of 4 anti-hypertensive agents. Irbesartan 37.5mg, hctz 6.25mg, amlodipine 1.25mg, and atenolol 12.5mg, together once daily. 12 to 15 pt reduction in systolic and 10 to 12 pt reduction in diastolic. No complaints of SE and no effects on lab values.
    Great opportunity for compounding into a combination med capsule.

    • Steve

      Hi, I am a student doing an informal project for my preceptor at my current rotation site which is a pharmacy that provides to and consults with LTC facilities. What is the link and/or title of this study so I can take a look into it?

      • Kim w

        You can also check out the Triumph trial, but that one was amlodipine, chlorthalidone and an ARB. That had an interesting cohort of primarily female patients

    • Jessica

      Except that the pill and cost burden for this type of management is very high.

  3. shiva keramati

    Lots of factors should be considered, most importantly patient’s specific criteria and comorbidities. Also increasing the strength of many antihypertensives won’t increase the risk of side effects whereas adding another agent might..


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Written By Eric Christianson

April 30, 2017

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