20/10 mmHg above target BP) because of evidence showing that only a minority of patients will achieve and maintain BP goals on monotherapy [There are a number of compelling reasons why early combination therapy should be used in patients with hypertension (Table A range of mostly two-drug antihypertensive SPCs is available [Owing to the CV and renal protective effects of RAS inhibitors, dual RAS blockade is currently under investigation, i.e. J Hypertens. Clin Ther. 2009, 69 (17): 2393-2414. 2007, 29 (4): 563-580. 2007, 55 (7): 1056-1065. 10.1038/jhh.2010.104.Touyz RM: Intracellular mechanisms involved in vascular remodelling of resistance arteries in hypertension: role of angiotensin II. 10.1038/sj.jhh.1001494.Williams B, Gosse P, Lowe L, Harper R: The prospective, randomized investigation of the safety and efficacy of telmisartan versus ramipril using ambulatory blood pressure monitoring (PRISMA I). Blood Press Monit. 2007, 25 (11): 2317-2324. 10.1185/03007995.2011.616490.Sharma AM, Bakris G, Neutel JM, Littlejohn TW, Kobe M, Ting N, Ley L: Single-Pill Combination of Telmisartan/Amlodipine vs Amlodipine Monotherapy in Diabetic Hypertensive Patients: an 8-week randomised, parallel group, double blind trial. But it can also help treat kidney failure. 2007, 6: 28-10.1186/1475-2840-6-28.White WB, Davidai G, Schumacher H: Impact of angiotensin receptor blockade in combination with hydrochlorothiazide 25 mg in 2121 patients with stage 1-2 hypertension. 10.1016/j.amjmed.2010.08.007.Fogari R, Mugellini A, Zoppi A, Lazzari P, Destro M, Rinaldi A, Preti P: Effect of telmisartan/hydrochlorothiazide vs lisinopril/hydrochlorothiazide combination on ambulatory blood pressure and cognitive function in elderly hypertensive patients. 2000, 321 (7274): 1440-1444. 10.3810/pgm.2009.03.1974.Philipp T, Smith TR, Glazer R, Wernsing M, Yen J, Jin J, Schneider H, Pospiech R: Two multicenter, 8-week, randomized, double-blind, placebo-controlled, parallel-group studies evaluating the efficacy and tolerability of amlodipine and valsartan in combination and as monotherapy in adult patients with mild to moderate essential hypertension. 2004, 145: 16-22.Lacourciere Y, Krzesinski JM, White WB, Davidai G, Schumacher H: Sustained antihypertensive activity of telmisartan compared with valsartan. 2011Burnier M: Telmisartan: a different angiotensin II receptor blocker protecting a different population?. 2008, 117 (7): 905-914. Hypertens Res. 2002, 360 (9349): 1903-1913.Law MR, Wald NJ, Morris JK, Jordan RE: Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials. 10.1016/S0149-2918(04)90129-4.Writing and editorial assistance was provided by Emma Fulkes, PhD, of PAREXEL, which was contracted by Boehringer Ingelheim for these services. J Hypertens. Can J Cardiol. 2009, 121 (2): 25-39. 2011, 4: 41-48.Parving HH, Brenner BM, McMurray JJ, de ZD, Haffner SM, Solomon SD, Chaturvedi N, Ghadanfar M, Weissbach N, Xiang Z, Armbrecht J, Pfeffer MA: Aliskiren Trial in Type 2 Diabetes Using Cardio-Renal Endpoints (ALTITUDE): rationale and study design. 10.1093/ndt/gfn721.Chrysant SG, Chrysant GS: Antihypertensive efficacy of olmesartan medoxomil alone and in combination with hydrochlorothiazide. When renin meets up with angiotensinogen, it thinks that angiotensinogen is too long of a word as well as too long of a protein and cuts off part of the protein turning it into angiotensin I. Angiotensin I floats through the bloodstream until it meets up with the endothelial cells which have angiotensin converting enzymes (ACE) on them.