Updated September 12, 2014.

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Millions of individuals take blood pressure lowering medications on a daily basis. Many need at least two different medications to help treat their blood pressure. Are some combinations of medications better than others? Why do doctors and other health professionals prescribe particular combinations of medication?  Are there some medication combination medications you should be wary of?

What makes a particular combination more effective than others?

This is my opinion, however, first understand that when two different medications are prescribed they are often working "different ways" to lower blood pressure. For example, the class of medications called the calcium channel blockers often work differently than the class of medications referred to as ACE Inhibitors. In addition to trying to minimize the degree of side effects, my thoughts are the best medication combinations have other protective effects/benefits in addition to lowering blood pressure. One of the best examples of this is the combination of an ACE Inhibitor and calcium channel blocker. On example of this is Lotrel, which the combination of Amlodipine (Norvac), a calcium channel blocker, and Benazepril (am ACE Inhibitor). ACE Inhibitors have heart protective effects and are also kidney protective. Amlodipine in particular, has significant stroke preventive effects. It also has heart protective effects as well.  I see a lot of individuals on these two classes of medications, either as a prescription "combo med" such as Lotrel, or as two different combinations together.

 

The most common types of "medication combinations" involve the combination of a certain class of medications with a diuretic, with hydrochlorothiazide being the diuretic in many of these combinations. Examples include an ACE Inhibitor/HCTZ combination (Zestoretic), Beta blocker/HCTZ combinations and Angiotensin Receptor Blocker/HCTZ combination (such as Benicar/HCTZ). 

The reason that diuretics are commonly prescribed together with other classes of anti-hypertensive medications are that they maximize the blood pressure lowering effect of the first class of medication. In addition to the diuretic able to help manage sodium levels, they also help to lower blood pressure by independently acting as blood vessel vasodilators. The addition of a diuretic is a common practice by many physicians when someone is on one medication and their blood pressure is still high.

Is The Maximum Dosage of One Medication Given Before Adding Another One?

There is not a simple yes or no to this answer. It depends on the medication that you are given and your  particular to that medication. For example, some individuals may develop leg swelling or edema at higher doses of amlodipine (Norvasc) that may preclude higher doses of this medication from being used. Higher doses of hydrochlorothiazide or other diuretics may cause the body to lose too much sodium, a condition called hyponatremia which can cause the sodium levels in the body to get very low. 

If someone is on a medication and is not having any medication reactions/side effects, I try to increase the dosage gradually to the maximum. Given that many individuals tend to have side effects of many medications, I tend to try to get them to an intermediate dose of that medication and I if I need to increase their dose of medication, doing so ever so slowly. 

Medication Combinations I Am Not So Fond Of

I hesitate giving beta blockers to elderly patient s because of potential side effects, including fatigue, depression, and dizziness. I also hesitate to use hydrochlorothiazide in  the elderly unless absolutely necessary because I tend to see the side effects of low sodium (hyponatremia), low potasssium (hypokalemia) and low magnesium (hypomagnesemia). The combination of these two medications together I am less than thriled about giving to an older individual.