Azilsartan medoxomil + chlorthalidone

The fixed combination of azilsartan with chlorthalidone covers hypertension through two mechanisms at once. The FDA Edarbyclor label describes two scenarios: moving a patient whose blood pressure was not held by monotherapy, and starting straight on the combination when a single drug clearly will not reach target. The starting dose is 40/12.5 mg once daily. The 2024 ESC guideline points the same way: treatment usually begins with two drugs at low dose, because target is reached faster and adherence runs higher than with stepwise addition. Laboratory follow-up is trickier than for a single agent: both components move potassium and the shift can go either way, so potassium, sodium and creatinine are checked 1–2 weeks after starting and after every dose change. In Spain this combination is not registered; in Russia it is sold as Edarbi Klo.

ICD-10: I10 · ICD-11: BA00

In resistant hypertension a sartan with a thiazide-like diuretic covers two of the three mandatory components of the regimen at once, leaving a calcium channel blocker to add. Chlorthalidone suits that role better than hydrochlorothiazide: a half-life of 40–60 hours holds the effect around the clock, and the CLICK trial (N Engl J Med 2021) showed it lowers blood pressure even in stage 4 chronic kidney disease, where thiazides were previously considered useless. The price of that duration is the same hypokalaemia, only stretched: the potassium drop shows up on day 5–14 rather than day two. The sartan in the combination absorbs part of that hit. One separate check in resistant hypertension is whether a second thiazide hides in another tablet of the regimen: indapamide next to this combination creates duplication with no gain in effect.

ICD-10: I10 · ICD-11: BA00