( Note for clarity: ARB/ACE are the same "class" of BP med. They relax the same blood vessels.)
First it's great to keep your BP In check. Without any doubt it's the easiest, "low hanging fruit", you can control that will make a difference to your long term health. High BP isn't just about heart attack and strokes, but the health of every organ.
Most people fail to do this. Most primary care doctors don't take it seriously enough. That's the theme you hear from top cardiologists year after year.
The reason the Cardiology associations have been moving to combo low dose multi-class treatment isn't just to get to the number though.
Even with the same BP reduction achieved with one class of BP drug, using 2 or more classes results in fewer heart attacks, strokes, less kidney failure, etc.
So it's not purely about lowering BP. The long term results are superior when 2 classes are used, In fact more recently, 3 classes shows even better results, and 4 even more so. There's pressure on the drug companies to develop ultra-low dose 4 class BP tablets for this reason. (you have to lower the dose of each med as they're added to the combination, with four classes requiring microdoses of each)
Each of these classes reduces blood pressure in different parts of the body, so getting to 120/70 by relaxing a larger area of blood vessels less (using low dose multiple classes), delivers better results than relaxing a more limited amount of vessels more, the way a single class, like ARB/ACE (or any single class BP med) would, even though they could both deliver 120/70.
"For people already on the combination(ARB/ACE) and stable, clinicians need to consider that prescribing just one of the two reduces cardiovascular events to the same extent and that **other therapeutic regimes have the potential to reduce cardiovascular events** and blood pressure to a greater degree."
