Table 1 Rationale for and potential advantages of early SPC antihypertensive therapy [10, 15, 16, 21]

Rationale:

1.

Monotherapy is not effective at reaching and maintaining BP goal in most patients

2.

Each difference of 20 mmHg usual SBP or 10 mmHg usual DBP is associated with a two-fold increase in vascular death

3.

Using lower doses of each agent reduces the likelihood of adverse events experienced with a single agent used at a higher dose

4.

Patients with comorbidities, such as renal disease, might benefit from the non-BP-lowering benefits of antihypertensive agents with complementary mechanisms of action

Potential advantages:

1.

Simplified treatment regimen, which is particularly relevant in older patients with comorbid diseases requiring complicated polytherapy

2.

Increased adherence and persistence compared with equivalent free-drug combinations

3.

Additive effects on BP control of individual components with different, complementary mechanisms of action

4.

Attenuation of recognised adverse events, such as reduced CCB-induced peripheral oedema and diuretic-induced metabolic changes with RAS blockers

5.

Lower costs through increased BP reductions