Initial combination therapy for rapid and effective control of moderate and severe hypertension

Franklin, Stanley S.; Neutel, Joel M.

doi:10.1038/jhh.2008.72

Cited by 14 publications

(12 citation statements)

References 72 publications

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“…Guidelines recommend combination therapy for the treatment of severe hypertension, initially a thiazide-type diuretic with an angiotensin-converting enzyme (ACE) inhibitor, an angiotensin receptor blocker (ARB), a b-blocker, or a calcium channel blocker (CCB). 5 However, treatment of severe hypertension has been shown to be inadequate, with a small proportion of patients achieving BP control, 4 which might be the result of a lack of lifestyle modifications or initiation of antihypertensive drug at inadequate doses or drug combinations.…”

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confidence: 99%

“…3 Early, effective, and rapid BP control in patients with severe hypertension is needed to significantly reduce CV risk and long-term adverse clinical outcomes. 4 Antihypertensive agents with favorable efficacy and safety profiles are required for the treatment of severe hypertension. Guidelines recommend combination therapy for the treatment of severe hypertension, initially a thiazide-type diuretic with an angiotensin-converting enzyme (ACE) inhibitor, an angiotensin receptor blocker (ARB), a b-blocker, or a calcium channel blocker (CCB).…”

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confidence: 99%

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LCZ696, a First‐in‐Class Angiotensin Receptor‐Neprilysin Inhibitor: The First Clinical Experience in Patients With Severe Hypertension

Kario

Tamaki

Okino

et al. 2015

J of Clinical Hypertension

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The safety of LCZ696, a novel angiotensin receptorneprilysin inhibitor, was evaluated for the first time in patients with severe hypertension in this 8-week, multicenter, open-label study. Thirty-five Japanese patients with either office systolic blood pressure (SBP) ≥180 mm Hg or diastolic blood pressure (DBP) ≥110 mm Hg received LCZ696 200 mg. If blood pressure was uncontrolled, the LCZ696 dose was increased to 400 mg after 2 weeks (if there were no safety concerns; n=32), followed by an optional addition of another antihypertensive drug (except angiotensin receptor blocker and angiotensin-converting enzyme inhibitor) after 4 weeks (n=21). Reductions in office SBP/DBP (baseline, 173.4 mm Hg/112.4 mm Hg) and pulse pressure (baseline, 61.0 mm Hg) at week 8 were 35.3/ 22.1 mm Hg and 13.2 mm Hg, respectively. The overall incidence of adverse events was 48.6% with no reports of dizziness, hypotension, or angioedema. The LCZ696-based regimen was generally well-tolerated and could present a treatment option for severe hypertension in Asian patients especially in reducing SBP and pulse pressure.

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confidence: 99%

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confidence: 99%

LCZ696, a First‐in‐Class Angiotensin Receptor‐Neprilysin Inhibitor: The First Clinical Experience in Patients With Severe Hypertension

Kario

Tamaki

Okino

et al. 2015

J of Clinical Hypertension

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“…4, 5, 13, 14, 15, 16 There is a consensus that initial combination therapy works for high-risk patients with stage-2 hypertension; however, this does not have current support as an optional treatment approach for wider use in primary hypertension. 11 Evidence supporting initial use of combination therapy for patients with stage-1 hypertension largely comes from recent findings from the ACCOMPLISH study.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of initiating treatment with valsartan/hydrochlorothiazide in patients with stage-1 or stage-2 hypertension

et al. 2009

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This prospective, 6-week, multicenter, double-blind study examined the benefits of initiating treatment with combination valsartan/hydrochlorothiazide (HCTZ) compared with initial valsartan monotherapy for 648 patients with stage-1 or stage-2 hypertension (age=52.6±10 years; 54% male; baseline blood pressure (BP)=161/98 mm Hg, 32% stage 1). Patients were randomized to valsartan 80 mg (V-low), valsartan 160 mg (V-high) or valsartan/HCTZ 160/12.5 mg (V/HCTZ), and electively titrated after weeks 2 and 4 to the next dosage level (maximum dose valsartan/HCTZ 160/25 mg) if BP remained >140/90 mm Hg. At end of the study, patients initiated with V/HCTZ required less titration steps compared with the initial valsartan monotherapy groups (63 vs 86% required titration by study end, respectively) and reached the target BP goal of <140/90 mm Hg in a shorter period of time (2.8 weeks) (P<0.0001) vs V-low (4.3 weeks) and V-high (3.9 weeks). Initial combination therapy was also associated with higher BP control rates and greater reductions in both systolic and diastolic BP from baseline (63%, −27.7±13/–15.1±8 mm Hg) compared with V-low (46%, −21.2±13/−11.4±8 mm Hg, P<0.0001) or V-high (51%, −24.0±13/−12.0±10 mm Hg, P<0.01). Overall and drug-related AEs were mild to moderate and were similar between V/HCTZ (53.1 and 14.1%, respectively) and the two monotherapy groups, V-low (50.5 and 13.8%) and V-high (50.7 and 11.8%). In conclusion, initiating therapy with a combination of valsartan and low-dose HCTZ results in early, improved BP efficacy with similar tolerability as compared with starting treatment with a low or higher dose of valsartan for patients with stage-1 and stage-2 hypertension.

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“…Around three quarters of patients with hypertension will require combination therapy in order to reach guideline-recommended BP goals [2, 3]. In high-risk hypertensive patients, the initial use of combination therapy may facilitate the achievement of BP goals [4] and help to lower the risk of target organ damage [2, 5–8].…”

Section: Introductionmentioning

confidence: 99%

“…In high-risk hypertensive patients, the initial use of combination therapy may facilitate the achievement of BP goals [4] and help to lower the risk of target organ damage [2, 5–8]. This supports a strategy aimed at combining antihypertensive agents with complementary mechanisms of action [3, 9].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Single-Pill Combination of Telmisartan 80 mg and Hydrochlorothiazide 25 mg in Patients with Cardiovascular Disease Risk Factors: A Prospective Subgroup Analysis of a Randomized, Double-Blind, and Controlled Trial

Bays

Gao

Völker

et al. 2013

International Journal of Hypertension

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Objective. Report of prespecified and post hoc subgroup analyses of a randomized, controlled trial comparing telmisartan 80 mg/hydrochlorothiazide 25 mg (T80/H25) combination therapy with T80 monotherapy, according to the presence of cardiovascular disease (CVD) risk factors. Methods. Hypertensive patients were randomized (2 : 1) to receive T80/H25 or T80 for 6 weeks, following a 1-week, low-dose, and run-in period. Systolic blood pressure (SBP) and diastolic BP reductions and BP goal achievement were evaluated in patients with CVD risk factors: presence of diabetes mellitus (DM), renal impairment, increased body mass index (BMI), and 10-year estimated risk for coronary heart disease (CHD). Results. In total, 888 patients received treatment. Overall, T80/H25 therapy significantly reduced SBP more than T80 monotherapy, irrespective of patient subgroup. In patients with DM, renal impairment, high BMI, and high CHD risk, BP goal achievement rates (<140/90 mm Hg) at Week 7, among those treated with T80/H25, were 52.8%, 52.8%, 50.6%, and 38.5%, respectively. More patients with DM reached a guideline-based BP goal (<130/80 mm Hg) at 7 weeks with T80/H25 than with T80 monotherapy (16.7% versus 8.8%). Rates of treatment-related adverse events were low and comparable across patient subgroups. Conclusions. Antihypertensive treatment with T80/H25 single-pill combination is effective and generally well tolerated, irrespective of the presence of CVD risk factors.

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Initial combination therapy for rapid and effective control of moderate and severe hypertension

Cited by 14 publications

References 72 publications

LCZ696, a First‐in‐Class Angiotensin Receptor‐Neprilysin Inhibitor: The First Clinical Experience in Patients With Severe Hypertension

LCZ696, a First‐in‐Class Angiotensin Receptor‐Neprilysin Inhibitor: The First Clinical Experience in Patients With Severe Hypertension

Effectiveness of initiating treatment with valsartan/hydrochlorothiazide in patients with stage-1 or stage-2 hypertension

Efficacy of Single-Pill Combination of Telmisartan 80 mg and Hydrochlorothiazide 25 mg in Patients with Cardiovascular Disease Risk Factors: A Prospective Subgroup Analysis of a Randomized, Double-Blind, and Controlled Trial

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