Adding a new medication is associated with better blood pressure lowering. In drug-treated patients with hypertension whose blood pressure (BP) is inadequately controlled, augmentation strategies include maximising the dose of a currently prescribed antihypertensive medication or adding another antihypertensive drug.

According to a cohort study in the United States, investigators identified 487,000 older hypertensive veterans (age, ≥65; 98% men) whose mean systolic BP was more than 130 mm Hg during two recent visits. In 178,000 of these patients, clinicians intensified drug treatment. In 25%, a new antihypertensive medication was added, and in 75%, the dose of a currently prescribed antihypertensive medication was maximised.

Compared with maximising medication dose, adding a new medication was associated with significantly less adherence to the BP intensification regimen at three months  and twelve months. Nevertheless, adding a new drug lowered BP considerably at three months and twelve months (by about 1 mm Hg, on average).

Adding medication class to control BP makes pharmacological sense and can lower the risk for side effects by maximising the dose of a single agent. However, this study shows that the modest improvement in BP control with multiple agents likely comes at the expense of lower adherence to multidrug regimens.

Ultimately, adding drugs for hypertension treatment requires collaborative decision making with patients to simplify medication regimens while controlling BP and minimising adverse effects.