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In titrating antihypertensive therapy, many clinicians prefer moderate-dose two-drug therapy over high-dose monotherapy. Japanese researchers compared these practices in a trial that involved older hypertensive patients (age range, 65–84; systolic blood pressure [BP], >140 mm Hg or diastolic BP, >90 mm Hg) with either diabetes or cardiovascular (CV) disease (symptomatic or asymptomatic).
Patients initially received the angiotensin-receptor blocker (ARB) olmesartan (Benicar; 20 mg daily); the 1164 patients whose BP remained >140/90 mm Hg then were randomized to receive either higher-dose olmesartan (40 mg daily) or to continue olmesartan (20 mg) and add a calcium-channel blocker (e.g., amlodipine, 2.5 or 5.0 mg daily). Diuretics or β-blockers…