the combination valsartan + amlodipine + hydrochlorothiazide has been shown to be safe and effective in lowering bp across a broad spectrum of hypertensive populations ( young and old , male and female , black and white ) with moderate to severe hypertension . by combining agents with differing antihypertensive mechanisms , this therapy reduces side effects of the individual classes while enhancing their actions . control rates are improved over dual therapy and are achieved more rapidly , thereby enhancing compliance . our contention is that use of such a triple - therapy combination could lead to better recognition of truly resistant hypertension , which is becoming an increasingly prevalent problem as society ages and becomes more obese .
recent guidelines for the treatment of hypertension have focused on the need for multiple medications to get most patients to goal blood pressure ( bp ) . 
 two to three different classes of antihypertensive agents are frequently required , increasing the risk of poor compliance with therapy . 
 hence , the guidelines have recommended starting with combination therapy in patients with bp that is over 20 mm hg systolic or 10 mm hg diastolic above goal . 
 the latest advance in treatment regimen has been the development of triple - therapy combinations of an angiotensin receptor blocker , amlodipine , and hydrochlorothiazide . 
 we review the pathophysiologic rationale for such a combination and the efficacy , safety , and tolerability of the first triple therapy that has become available : valsartan + amlodipine + hydrochlorothiazide . finally , we suggest that use of triple therapy could improve the accuracy of diagnosing resistant hypertension , an increasingly prevalent and severe condition , by enhancing adherence to treatment and weeding out patients with pseudoresistance . 
 this would allow for implementation of expensive and invasive workup only in those truly resistant patients in whom it is justified .