Fixed combination of irbesartan and hydrochlorothiazide in the management of hypertension

Abstract

Approximately 25% of the adult population worldwide is hypertensive and thus at risk of cardiovascular morbidity and mortality. Despite the availability of many antihypertensive drugs, at least 50% of patients do not achieve blood pressure (BP) targets and thus remain at increased cardiovascular risk. Fixed-dose (FD) irbesartan/hydrochlorothiazide (HCTZ) is an antihypertensive combination therapy approved for the treatment of patients whose BP is not adequately controlled on monotherapy and for initial treatment of patients likely to need multiple drugs to achieve their BP goal. The effi cacy and tolerability of FD irbesartan/HCTZ has been demonstrated in both patient populations in large multicenter studies. In patients failing antihypertensive monotherapy, FD irbesartan/HCTZ (150/12.5 mg) has been shown to be more effective than FD valsartan/HCTZ (80/12.5 mg) and at least comparable to FD losartan/HCTZ (50/12.5 mg). In patients with moderate or severe hypertension receiving FD irbesartan/HCTZ as initial therapy, this combination achieved more rapid BP reductions compared with irbesartan monotherapy and enabled a greater proportion of patients with severe hypertension to achieve their BP target. FD irbesartan/HCTZ is thus a valuable addition to the clinician's armamentarium for the management of hypertension and should help more patients achieve their BP target. Keywords: blood pressure control, blood pressure target, combination therapy, angiotensin receptor blockers Management issues in treating hypertensionHypertension is a major cause of morbidity and mortality and an important public health challenge worldwide. It has been estimated that hypertension is responsible for approximately two-thirds of all strokes and 50% of heart attacks worldwide. 1In addition, hypertension causes 7.1 million premature deaths per year worldwide and is responsible for 4.5% of the global burden of disease.1 This startling impact of hypertension on health worldwide in part refl ects the high prevalence of hypertension. According to a recent review of published literature, approximately a quarter of the adult population worldwide (26.4%) was hypertensive in 2000 and this is expected to increase to 29.2% by 2025.2 Appropriate management of hypertension is therefore an important priority worldwide, especially given the impact that effective blood pressure (BP) control can have on morbidity and mortality.Effective BP control has been shown to signifi cantly reduce morbidity and mortality, as demonstrated in a meta-analysis of data from trials of active antihypertensive treatment compared with placebo.3 According to this analysis, active antihypertensive treatment in hypertensive patients signifi cantly reduced the risk of fatal and nonfatal stroke by approximately 40% and coronary heart disease (CHD) by approximately 15%, while all-cause mortality was reduced by approximately 15% and cardiovascular mortality by approximately 20%. In addition, a meta-analysis of data from 61 prospective observational studies has shown that t...

Significance of initial blood pressure and comorbidity for the efficacy of a fixed combination of an angiotensin receptor blocker and hydrochlorothiazide in clinical practice

“…15 A range of studies has shown that the higher the initial value, the higher the achievable reduction in blood pressure 16,17 or the more common is the normalization of blood pressure after the start of therapy [16][17][18][19] (see also Figure 4). This might be related to a regression to the mean phenomenon in single patients but certainly not in the majority of patients in this study of more than 8123 patients.…”

Role of olmesartan in combination therapy in blood pressure control and vascular function

“…In several observational studies, fixed-dose combinations were associated with higher rates of compliance, persistence, and adherence to treatment regimens 75–82. A meta-analysis of 15 published studies with a total of 32,331 patients concluded that fixed-dose combinations of antihypertensive agents were associated with increased compliance and no changes in the frequency of adverse events when compared with free drug components given separately 80…”

Aging in blood vessels. Medicinal agents FOR systemic arterial hypertension in the elderly

“…It has been proposed that during long-term therapy, thiazides act by reducing total peripheral resistance probably through a direct vascular effect. Thiazides reduce water reabsorption in the distal convoluted tubules and thereby diminish plasma volume and cardiac output (Bramlage, 2009;Raheja et al, 2012).…”