How do I take two medications for hypertension?

From the Guidelines

To effectively take two medications for hypertension, it is recommended to follow a combination therapy with an ACE inhibitor or ARB plus a CCB or diuretic, as initial therapy, and to take the medications consistently at the same time each day to maintain steady blood levels, as suggested by the most recent guidelines 1. When taking two medications for hypertension, it is essential to follow your doctor's specific instructions for each medication, including the prescribed dosage and timing.

• Typically, you would take each medication at the times prescribed, which might be once or twice daily depending on the specific drugs.
• Common hypertension medication combinations include an ACE inhibitor (like lisinopril) with a diuretic (like hydrochlorothiazide), or a calcium channel blocker (like amlodipine) with an ARB (like losartan). Some key points to consider when taking these medications include:
• Taking medications consistently at the same time each day to maintain steady blood levels.
• Checking the specific instructions for each medication to determine if they should be taken with food or on an empty stomach.
• Keeping track of your blood pressure readings at home to monitor effectiveness.
• Contacting your doctor if you experience side effects like dizziness, fatigue, or swelling, rather than stopping medications on your own. It is also important to note that using combination therapy is often more effective than single-drug treatment because the medications work through different mechanisms to lower blood pressure, allowing for lower doses of each medication and potentially fewer side effects, as supported by recent studies 1. In terms of specific medication combinations, the 2024 ESC guidelines for the management of elevated blood pressure and hypertension recommend that among all BP-lowering drugs, ACE inhibitors, ARBs, dihydropyridine CCBs, and diuretics have demonstrated the most effective reduction of BP and CVD events, and are therefore recommended as first-line treatments to lower BP 1. Additionally, it is recommended to avoid combining two RAS blockers, such as an ACE inhibitor and an ARB, as this can increase cardiovascular and renal risk, as highlighted in previous studies 1.

From the FDA Drug Label

Many patients will require more than 1 drug to achieve blood pressure goals. Lisinopril tablets USP may be administered alone or with other antihypertensive agents [see Clinical Studies (14.1)].

To take two medications for hypertension, follow the specific advice of your healthcare provider. The FDA drug label for lisinopril indicates that it may be administered alone or with other antihypertensive agents. However, the label does not provide specific instructions on how to take two medications for hypertension. Consult your healthcare provider for guidance on taking multiple medications 2.

From the Research

Taking Two Medications for Hypertension

To take two medications for hypertension, it is essential to understand the different types of medications and their interactions.

• The first-line treatment for hypertension is usually a thiazide diuretic, such as chlortalidone or hydrochlorothiazide 3.
• Angiotensin-converting enzyme (ACE) inhibitors, such as lisinopril, can also be used as a first-line treatment or in combination with a thiazide diuretic 3, 4.
• When taking two medications, it is crucial to monitor blood pressure and adjust the dosage as needed to avoid adverse effects.

Combination Therapy

Combination therapy with a thiazide diuretic and an ACE inhibitor can be effective in reducing blood pressure and preventing cardiovascular complications 4, 5.

• Studies have shown that the combination of benazepril or perindopril with hydrochlorothiazide (HCTZ) or indapamide (IND) can result in a favorable clinical outcome 4.
• The addition of a diuretic to an ACE inhibitor can also be beneficial in patients who are not controlled on ACE inhibitor therapy alone 6, 5.

Safety and Efficacy

The safety and efficacy of combination therapy should be carefully evaluated, taking into account the potential risks and benefits.

• Thiazide diuretics can provoke hyperglycemia and diabetes, although this does not reduce their efficacy in preventing cardiovascular events 3.
• The combination of ACE inhibitors and diuretics is generally safe and well-tolerated, with a lower rate of major adverse events compared to other combinations 4.