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interdict all offending pathways. Also, as higher doses Diuretics and b-blockers are appropriate agents to of individual drugs are administered, there is an incombine in hypertension treatment because they creased likelihood of producing untoward side effects lower blood pressure more effectively in combination and stimulating the body’s compensatory mechathan when either is used as monotherapy. The bnisms, which may partially attenuate the incremental blocker can counteract diuretic-induced rises in gain in efficacy. plasma renin activity 14 and sympathetic nervous sysDiuretics and b-adrenergic blocking drugs are the tem outflow, while modifying diuretic-induced hypoonly two classes of antihypertensive drugs that have kalemia (Figure 1) . been tested and shown to reduce morbidity and morA large number of fixed-dose diuretic/b-blocker tality. They have been recommended as preferred iniformulations are commercially available using contial therapy in patients with systemic hypertension. ventional doses of thiazides (hydrochlorothiazide They are often combined to maximize blood pressure [HCTZ] , 25 to 50 mg daily) and various b-blockers control either as separate agents or in single fixed( labetalol, metoprolol, propranolol, extended-release dose formulations. The advantages of a single propranolol, and timolol ) , as well as 5 mg benfixed-dose formulation are the simplicity and convedroflumethiazide with nadolol, and 25 mg chlorthalinience of use, which lead to improved patient complidone with atenolol (Table 1 ) . Recent reports have ance and possible reduction in cost. The possible dissuggested that these fixed-dose formulations can be advantages include a reduced flexibility in dosage and used as initial therapy in hypertension treatment, but the fact that the combination formulation may be too only after each individual component has been tipotent for initiating therapy. These problems may be trated to the appropriate level ( the concept implies

Results of Hypertension Treatment With Low-Dose Combinations of a ?-Adrenergic Blocker and a Diuretic