Introduction Hypertension is heterogeneous in treatment response. Recently, the aggressive use of fixed-dose combination therapy will increase the rate of response. This approach may offer more efficacy and tolerability with simplicity. However, titration of drug combination is still challenging. Methods 572 hypertensive patients (mean age 57 ±15 years, 47% female) treated with amlodipine and telmisartan combinations were followed from January 2005 to May 2010. Patients with other cardiovascular co-morbidities; valvular heart disease, coronary artery disease, stroke and diabetes were excluded. Office systolic and diastolic blood pressure, transthoracic echocardiography, and plasma rennin activity level were checked. Down-titration is decided telmisartan dose reduction 80mg to 40mg or maintaining amlodipine 5mg only. Up-titration is decided telmisartan dose 40mg to 80mg or adding hydrochlorothiazide 12.5mg with previous treatment. Results 356 patients (62.2%) were not changed their first combination therapy. 162 patients (28.3%) were down titrated and 54 patients (9.4%) were up titrated the drug doses of combination. Baseline office systolic and diastolic blood pressure, age, and sex were similar in these three groups. Follow-up blood pressure (132±17/79±10 vs. 145±16/84±10, p=0.0001), left ventricle (LV) posterior wall thickness (9.6±1.2 vs. 10.2±1.3, p=0.003) and LV mass index (96.6±21.0 vs. 104.7±26.2, p=0.041), and plasma rennin activity (4.1±7.3 vs. 1.8±2.2, p=0.01) was significantly different between down-titration and up-titration group. Conclusion Treatment algorithm based on office blood pressure, echocardiographically left ventricular structure and plasma rennin activity provides more effective blood pressure control in patient with fixed dose combination antihypertensive-therapy.
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