Achieving Goal Blood Pressure in Patients With Type 2 Diabetes: Conventional Versus Fixed‐Dose Combination Approaches

Abstract

Data from the Third National Health and Nutrition Examination Survey (NHANES III) demonstrate that only 11% of people with diabetes who are treated for high blood pressure achieve the blood pressure goal of <130/85 mm Hg recommended in the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). The current study tests the hypothesis that initial therapy with a fixed-dose combination will achieve the recommended blood pressure goal in patients with type 2 diabetes faster than conventional monotherapy. This randomized, double-blind, placebo-controlled study had as a primary end point achievement of blood pressure <130/85 mm Hg. Participants (N=214) with hypertension and type 2 diabetes received either amlodipine/benazepril 5/10 mg (combination) or enalapril 10 mg (conventional) once daily for 4 weeks, titrated to 5/20 mg/day or 20 mg/day, respectively at this time, if target blood pressure was not achieved. Hydrochlorothiazide (HCTZ) 12.5 mg/day was added for the final 4 weeks, if target blood pressure was still not reached. Time from baseline to achieve blood pressure <130/85 mm Hg was shorter in the combination group (5.3+/-3.1 weeks combination vs. 6.4+/-3.8 weeks conventional; p=0.001). At 3 months, more participants in the combination group achieved treatment goal (63% combination vs. 37% conventional; p=0.002). Data analysis at 3 months comparing blood pressure control rates between the fixed-dose combination group (without HCTZ) to the conventional group (receiving HCTZ) showed an even greater disparity in blood pressure goal achievement (87% combination without HCTZ vs. 37% conventional group with HCTZ; p=0.0001). We conclude that initial therapy with a fixed-dose combination may be more efficacious than conventional monotherapy approaches for achieving blood pressure goals in the diabetic patient. A fixed-dose combination approach appears as safe as the current conventional approaches.

Comparative efficacy and safety of amlodipine/benazepril combination therapy and amlodipine monotherapy in severe hypertension

“…We identified a substantial effect of A therapy (B25/11 mm Hg) and an additional BP lowering (B5/3 mm Hg) attributable to the combination of amlodipine and benazapril. The observation that BP control rates in this study are lower than those reported in other studies, 6,7 owes, at least in part, to the very high baseline SBP and DBP measurements that were present (about 175/100 mm Hg); thus, a mean decrease in SBP of 435 mm Hg and DBP of 420 mm Hg would have been necessary to achieve BP control in the majority of subjects. More important is the strict guideline-based definition of BP control that was used (o140/90 in general or o130/80 mm Hg in subjects with diabetes or CKD).…”

“…More important is the strict guideline-based definition of BP control that was used (o140/90 in general or o130/80 mm Hg in subjects with diabetes or CKD). We have found only two studies with limited similarity: SOLACE by Jamerson et al 6 and SHIELD by Bakris et al, 7 in which BP control rates were 61 and 63%, respectively. Each of these studies was of 12 weeks in duration, whereas our study was much shorter (6 weeks).…”

Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study

“…The improvement in BP following the correction of Atlas misalignment is similar to that seen by giving two different antihypertensive agents simultaneously. 11,12 Moreover, this reduction in BP persisted at 8 weeks and was not associated with pain or pain relief or any other symptom that could be associated with a rise in BP.…”

Targeting mechanisms of hypertensive vascular disease with dual calcium channel and renin–angiotensin system blockade

“…Combining classes of agents with complementary mechanisms of action, such as CCBs and RAS blockers, provides greater BP-lowering efficacy than monotherapy, [68][69][70][71][72][73][74][75] with a comparable and potentially improved adverse-event profile. 76 However, few trials have been designed to test the effect of specific antihypertensive combinations on cardiovascular or renal end points.…”