Rationale for the Use of Fixed Combination Therapies with Angiotensin Converting Enzyme Inhibitors and Beta-Blockers in Patients with Essential Hypertension and High Cardiovascular Risk: A Consensus Document from the Italian Society of Arterial Hypertension (Siia) and the Italian Society of Cardiovascular Prevention (SIPREC)

: Essential hypertension represents the main risk factor for coronary events, including acute myocardial infarction, coronary syndromes, and unstable angina, as well as for chronic coronary artery disease (CAD). It also increases the risk of peripheral artery disease and chronic kidney disease, thus contributing to worsen prognosis, deteriorating quality of life, favouring unplanned hospitalizations due to cardiovascular (CV) causes, and affecting elevated costs for health care systems. Moreover, hypertension may contribute to development and progression of left ventricular (LV) remodelling and dysfunction, which may, in turn, promote the onset of cardiac arrhythmias, mostly atrial fibrillation (AF), and congestive heart failure with preserved ejection fraction (HFpEF). All these clinical conditions related to hypertension can be included in the definition of high or very high CV risk profile. Lowering blood pressure (BP) levels to the recommended therapeutic targets is a mandatory step for reducing the burden of hypertension-related CV complications, as well as for improving quality of life and event-free survival in patients with hypertension at high or very high CV risk. Current guidelines recommend the use of combination therapies, possibly in fixed formulations, even as first-line therapy, in almost all patients with hypertension, including those at high or very risk CV risk profile. Such combination therapies have proven to lower BP, reduce CV morbidity and mortality, as well as the risk of hospitalization due to CV causes. In particular, combination therapies based on the use of an angiotensin-converting enzyme (ACE) inhibitor plus a beta-blocker (BB) have demonstrated to be effective in lowering BP and heart rate, promoting reverse cardiac and vascular remodelling, and reducing CV morbidity and mortality in patients with hypertension and chronic CAD, cardiac arrhythmias, or HFpEF. This consensus document, endorsed by the Italian Society of Hypertension (SIIA) and the Italian Society for Cardiovascular Prevention (SIPREC), will discuss the available evidence and clinical indications supporting the use of fixed combination therapies based on ACE inhibitors plus BBs in patients with hypertension and high or very high CV risk profile, including those with chronic CAD, cardiac arrhythmias, or HFpEF.