OBJECTIVES: To compare the effectiveness of dual combinations of angiotensin II receptor blockers (ARBs) and ACE Inhibitors (ACEIs) with hydrochlorothiazide (HCTZ) or Calcium Channel Blockers (CCBs) in reaching target blood pressure (BP) in a real-world setting. METHODS: Records from a longitudinal population-based database of more than 170,000 patients in over 53 family practice clinics in southwestern Ontario, Canada were analyzed.  These records contained chart-abstracted information such as visit diagnosis, BP, medications and consultation notes.  The records from adult non-diabetic patients who were diagnosed with hypertension and were initiated on the combination therapy in 2005 and continued on the combination for at least 9 months were included.  Hypertension was defined as a BP exceeding 140/90 mmHg, chart entry of a diagnosis of hypertension, or use of anti-hypertensive medication. The proportions of patients reaching target BP (BP less than 140/90 mmHg) were recorded and the combination of ARBs+HCTZ was compared to other combinations.  Due to the well known comparable safety profile of the compounds, a safety analysis was not performed. RESULTS: A total of 4,458 patients were treated with dual combinations of ARBs and ACEIs with HCTZ or CCBs.  The proportions of patients reaching target BP were 35% on ARBs + HCTZ compared to 30% on ACEIs+HCTZ (p=0.006), 32% on ARBs+CCBs (p=0.03), and 28% on ACEIs+CCBs (p=0.001). CONCLUSIONS:   In the real-world setting, a greater proportion of hypertensive patients treated with the dual combination ARB+HCTZ reached target BP than the dual combinations of ARB+CCB, ACEI+HCTZ, or ACE+CCB.  Patients treated with the combination of an ARB with HCTZ or CCB achieved target BP in a greater proportion than patients treated with ACEI-based counterparts.