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Ultralow-dose quadruple combination therapy: a cost-effective solution for hypertension control
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    A more accurate definition of clinical inertia

    It is, indeed, a truism that poor rates blood pressure(BP) control are, in part, attributable to clinical inertia, whereby therapy is not escalated when BP is uncontrolled[1]. However, the criterion for escalation of antihypertensive therapy utilised by the authors, namely, a BP amounting to 140/90 mm Hg or more[1], is inappropriate, given the fact that the goal BP most likely to mitigate the risk of incident hypertension-related atrial fibrillation(AF) and hypertension-related congestive heart failure(CHF), respectively, is a goal BP amounting to < 120/80 mm Hg[2],[3]. In principle, that goal BP can be achieved by ultralow-dose quadruple combination therapy either on its own or in combination with lifestyle antihypertensive strategies such as regular exercise[4] and low-salt diet with or without abstinence from alcohol[5]. The younger the patient the more compelling the requirement to attain a BP amounting to < 120/80 mm Hg because it is theoretically possible that the longer the duration of suboptimal blood pressure the greater the long term risk of AF, CHF, and, arguably, hypertension-related vascular dementia[6].
    Attainment of optimum goal BP crucially depends on accurate measurement of both "office" and home blood pressures[7],[8], and both those goals are predicated on the use of well-validated blood pressure monitors[8]. However, the minimum requirement for ultimate success in the control of BP is an honest conversation between doctor...

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    Conflict of Interest:
    None declared.