Combination therapy as first-line treatment for hypertension

Gavras, Irène; Rosenthal, Talma

doi:10.1007/s11906-004-0020-x

Cited by 24 publications

(14 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These findings are consistent with the recent trends advocating the use of combination therapy as a first line treatment. [10][11][12] Our observation that patients on combination therapy had significantly higher reduction in systolic and diastolic blood pressures than those on monotherapy further confirm the previously described benefits of antihypertensive combination therapy.…”

Section: Discussionsupporting

confidence: 81%

Prescription pattern of anti-hypertensive drugs in a tertiary health institution in Nigeria

Isezuo

Chika

et al. 2008

Ann Afr Med

View full text Add to dashboard Cite

Objective: This study examined the pattern of physicians' prescription of antihypertensive drugs and its possible effects on blood pressure control as well as physicians' compliance with recommended guidelines. Methods: Records of 145 patients aged 17-91 (mean: 52.6 ± 14.6) years, with male to female ratio of 1:1.2 were randomly selected. Information on antihypertensive prescriptions was recorded. Blood pressure control was defined as systolic and diastolic blood pressure less than 140 mm Hg and 90mmHg, respectively. Results: Of the 145 patients studied, 20% (29) were on monotherapy and 80% (116) on combination therapy. Of the patients on combination therapy, 61.2% (71), 33.6% (39) and 5.2% (6) were on 2, 3 and 4 drugs, respectively. Diuretic was the most frequently prescribed drug either as a single agent (44.8%) or as combination therapy (88.8%). Mean reductions in both systolic and diastolic blood pressures were more in patients on calcium channel blocker than those on diuretic monotherapy (t = 2.5 and 3.6 for reductions in systolic and diastolic BP, respectively; P < .05 for both), and, in patients on combination therapy than those on monotherapy (t = 3.64 and 3.27 for reductions in systolic and diastolic BP, respectively; P < .01 for both). Blood pressure control rate was 30.5%. Conclusion: Our results are consistent with the previously observed benefits of antihypertensive combination therapy, and demonstrate an apparent higher efficacy of calcium channel blocker monotherapy than diuretic monotherapy in blood pressure lowering in the study population. Major limitations of this work include its retrospective nature and the inability to determine the actual patients' adherence to therapy. Page | 129 8%) ou en combinaison avec d'autres agents antihypertenseurs. La réduction moyenne dans les deux cas de systolique et diastolique était plus élevée chez les patients prenant les diurétiques tout court. (= 2.5 et, 3.6 pour la réduction en systolique et diastolique respectirement; p<0.05 pour les deux cas), et chez les patients en thérapie combinée que chez ceux en monothérapie (t = 3,64 et 3, 27 pour la réduction en systolique et diastolique respectivement; p< 0.01) pour les deux cas_. Le taux de contrôle était 30, 5%. Conclusion: Nos résultats correspondent aux bénéfices déjà observés dans le régime de la thérapie antihypertensive combinée, et montre une efficacité clairement élevée de beta-bloquants de calcium (la chaine de bloquants de calcium) utilisés en monothérapie que les diurétiques utilisés en monothérapie dans l'abaissement de la tension artérielle au sein de l'échantillon de l'étude.

show abstract

Section: Discussionsupporting

confidence: 81%

Prescription pattern of anti-hypertensive drugs in a tertiary health institution in Nigeria

Isezuo

Chika

et al. 2008

Ann Afr Med

View full text Add to dashboard Cite

show abstract

“…It is generally admitted that the HBP management starts by monotherapy at an efficient dose which is going to be a substitute for combinations which are recommended in recent tendencies as first line treatment [20][21][22]. The bitherapy was at the top of prescriptions having allowed to control the disease in 53.49% of ambulatory patients against 39.13% of hospitalized patients.…”

Section: Discussionmentioning

confidence: 99%

Effect of Antihypertensive Drug Therapy on the Blood Pressure Control among Hypertensive Patients Attending Campus’ Teaching Hospital of Lome, Togo, West Africa

Potchoo¹,

Goe-Akue²,

Damorou³

et al. 2012

View full text Add to dashboard Cite

High blood pressure (HBP) is a health problem worldwide. In Togo, that affection constitutes a more and more preoccupying cause of morbidity and mortality. This study is a prospective one which intended to identify the antihypertensive regimens prescribed and evaluate their effect on patients' blood pressure (BP) control. Out of the 204 patients enrolled (mean: 55.01  12.55 years; sex ratio: 1.3), 112/176 placed on antihypertensive therapy have controlled their BP (38.39% outpatients vs 61.61% inpatients). Related to the sex factor, we didn't observe any significant difference in the BP control. Whereas, the mean median value of BP reduction of outpatients (30.00/15.00 mmHg) (p = 0.001) was half lower than that of inpatients (60.00/30.00 mmHg (p = 0.004)). Thirty five outpatients (81.40%) vs 64 inpatients (92.75%) were placed on combination therapy. The bitherapy was prescribed to 23 outpatients (53.49%) against 27 inpatients (39.13%) while the quadritherapy and more than 4 drugs combination were prescribed exclusively to inpatients (20.29%, n = 14). That quadritherapy induced a significant mean reduction of inpatients' SBP compared to monotherapy (p = 0.043) and to bitherapy (p = 0.004). The favorite combinations were D + CCA, D + ACEI, D + CCA + ACEI and D + CCA + ACEI + CAAD of which the quadruple therapy showed a significant inpatients' DBP control (p = 0.015) compared to D + CCA combination. The combinations including at least one diuretic induced a significant difference between outpatients (median value: 30.000/10.000 mmHg) (p  0.001) and inpatients (median value: 60.000 mmHg/30 mmHg) (p  0.001). The first-line molecules and fixe combinations prescribed in decreasing frequency were among others: hydrochlorothiazide + captopril, nicardipine,  methyldopa for outpatients; furosemide, nicardipine, captopril,  methyldopa, hydrochlorothiazide + captopril for inpatients. Diuretics, CCAs and ACEIs were the 3 favorite pharmacological groups for essential hypertension management in our African resource limited context. Combined to CAAD, they represented the best quadruple combination among inpatients having showed a significant difference in DBP control compared to D + CCA combination.

show abstract

“…Therefore, various combinations of antihypertensive agents have been marketed, and recent clinical guidelines for the treatment of hypertension recommend a combination therapy for appropriate blood pressure control (Chobanian et al, 2003;Whitworth, 2003;Gavras and Rosenthal, 2004;Rosenthal and Gavras, 2006). The advantage of a first-line treatment for hypertension with combination therapy compared with monotherapy are as follows: 1) there is some synergistic action when using two or more drugs that have different mechanisms of actioni.e.…”

Section: Introductionmentioning

confidence: 99%

Beneficial effects of the combination of amlodipine and losartan for lowering blood pressure in spontaneously hypertensive rats

et al. 2009

View full text Add to dashboard Cite

A combination of antihypertensive agents can better control blood pressure and reduce the number and severity of side effects than a monotherapy. Since both CCBs (calcium channel blockers) and ARBs (angiotensin II receptor type-1 blockers) are current and effective antihypertensive drugs, this study assessed the synergistic antihypertensive effects as well as the optimal combination ratio of these two drugs. Amlodipine (3 mg/kg) or losartan (30 mg/kg) alone or a combination of each drug at a ratio 1:10 and 1:20 was administered orally to spontaneously hypertensive rats (SHR). A four-week treatment of either 3 mg/kg amlodipine or 30 mg/kg losartan alone decreased the systolic blood pressure (SBP). However, their combination significantly lowered the SBP from the 3(rd) week, and there was a positive correlation between this reduction in blood pressure and the improvement in arterial endothelium-dependent relaxation. In addition, the combination therapy (1:20) decreased both the cardiac mass and left ventricular weight to a greater extent than with either amlodipine or losartan alone. The collagen content in the cardiac tissue was also significantly lower after the 4-week combination therapy (1:10). These results suggest that the combined use of amlodipine and losartan might be more effective in treating hypertension than a monotherapy.

show abstract

Combination therapy as first-line treatment for hypertension

Cited by 24 publications

References 42 publications

Prescription pattern of anti-hypertensive drugs in a tertiary health institution in Nigeria

Prescription pattern of anti-hypertensive drugs in a tertiary health institution in Nigeria

Effect of Antihypertensive Drug Therapy on the Blood Pressure Control among Hypertensive Patients Attending Campus’ Teaching Hospital of Lome, Togo, West Africa

Beneficial effects of the combination of amlodipine and losartan for lowering blood pressure in spontaneously hypertensive rats

Contact Info

Product

Resources

About