Table 1 Pharmacological rationale of combination therapy
Combinations | Mechanisms | |
|---|---|---|
ARB-Diuretic | ARBs cause the antagonism of angiotensin II at the vascular and myocardial level by direct AT-1 receptor blockade | Thiazide diuretic blocks sodium chloride reabsorption at the distal convoluted tubule |
β-Adrenoceptor Antagonist-Diuretic | The β-adrenoceptor blocker inhibits activation by direct suppression of renin release, inhibit β-adrenergic sympathetic stimulation decreasing myocardial contractility and heart rate | Diuretics as above |
ACEI-Diuretic | ACEI cause the removal of the angiotensin II effect (vasoconstriction, stimulation of aldosterone secretion) and enhancement of kinin-mediated vasodilation | Diuretics as above |
ACEI-CCB | ACEI as above | The calcium antagonists de-crease vascular resistance by vascular smooth muscle relaxation |
ARB-CCB | ARBs as above | CCBs as Above |
ACE-ARB Inhibitors | ACEI as above | ARBs as above |
Centrally Acting Agents-Diuretic | Clonidine acts by decreasing sympathetic outflow by stimulating pre synaptic α2-adrenoceptors in the vasomotor centre of the CNS. | Diuretics as above |