Publication:

A contemporary review on combination therapy for hypertension management in India

Hypertension affects nearly one-third of Indian adults, yet only one in six patients achieve adequate blood pressure control. This narrative, evidence-informed review synthesizes data from PubMed, Scopus and Google Scholar (2000–2025) on antihypertensive combination therapy, with additional focus on Indian epidemiology and prescribing patterns. Evidence suggests that early initiation of combination therapy—particularly as single-pill combinations (SPCs)—may offer more rapid and sustained blood pressure reduction by targeting multiple pathophysiological pathways simultaneously. Indian patients have a unique cardiometabolic phenotype characterized by increased abdominal obesity, diabetes, dyslipidemia, heightened sympathetic tone, elevated resting heart rate, and enhanced renin-angiotensin-aldosterone system (RAAS) activation, resulting in higher cardiovascular risk at younger ages. This review evaluates clinical evidence from dual, triple, and quadruple combination trials, summarizes current global and regional guideline recommendations, and highlights gaps in Indian practice, including persistent underutilization of combination regimens in moderate- to high-risk patients. The objective is to review global evidence for Indian clinical practice and discuss strategies for optimizing risk-stratified hypertension management.