Initial Monotherapy and Combination Therapy and Hypertension Control the First Year

Abstract

Initial antihypertensive therapy with single-pill combinations produced more rapid blood pressure control than initial monotherapy in clinical trials. Other studies reported better cardiovascular outcomes in patients achieving lower blood pressure during the first treatment year. We assessed the effectiveness of initial antihypertensive monotherapy, free combinations, and single-pill combinations in controlling untreated, uncontrolled hypertensives during their first treatment year. Electronic record data were obtained from 180 practice sites; 106,621 hypertensive patients seen from 01/2004–06/2009 had uncontrolled blood pressure, were untreated for ≥6 months before therapy, and had ≥1 one-year follow-up blood pressure data. Control was determined by the first follow-up visit with blood pressure <140/<90 mm Hg for patients without diabetes mellitus or chronic kidney disease and <130/<80 for patients with either or both conditions. Multivariable hazards regression ratios (HR) and 95% confidence intervals (95%CI) for time-to-control were calculated adjusting for age, sex, baseline blood pressure, body mass index, diabetes, chronic kidney disease, cardiovascular disease, initial therapy, final blood pressure medication number, and therapeutic inertia. Patients on initial single-pill combinations (N=9,194) were more likely to have Stage 2 hypertension than those on free combinations (N=18,328) or monotherapy (N=79,099 [all p<0.001]). Initial therapy with single-pill combinations (HR 1.53, 95%CI 1.47–1.58) provided better hypertension control in the first year than free combinations (HR 1.34, 95%CI 1.31–1.37) or monotherapy (reference) with benefits in black and white patients. Greater use of single-pill combinations as initial therapy may improve hypertension control and cardiovascular outcomes in the first treatment year.

Polypharmacy Treatment of Hypertensionin Public Health Centers

“…A previous study in South Carolina showed that 74.2% of patients received one antihypertensive pill and medication category. 5 This might be because the target blood pressure could be obtained Note:ACEI= Angiotensin-converting enzyme inhibitor using a single drug therapy. From the current study, a single drug therapy with ACE inhibitors (58.62%) was more strongly associated with good control of blood pressure than monotherapy with beta-blockers, CCBs, diuretics, or the use of multiple drugs.…”

Hemodynamic Stability of Hypertension Patient: Triple Therapy Opportunities

“…В настоящее время 74,2% пациентов используют монотерапию, 17,2% СК и только 8,6% ФК [29]. С комбинации антигипертензивных препаратов начинают лечение лишь 25,8% пациентов АГ [29].…”

“…С комбинации антигипертензивных препаратов начинают лечение лишь 25,8% пациентов АГ [29]. В сравнении с монотерапией, инициация АГТ в режиме СК позволяет лучше контролировать АД на 34% (ОР 1,34; ДИ 1,31-1,37), а в режиме ФК на 53% (ОР 1,53; ДИ 1,47-1,58) [29].…”

“…Клинически значимыми преимуществами ФК являются: потенциальный синергический эффект в достижении прогностически значимых конечных точек; эффективность в отношении резистентной АГ [16,31]; эффективность в условиях коморбидной патологии: СД [29,30], ХПБ [10] и меньшее число побочных эффектов [20]. У лиц с высоким АД или с высоким сердечно-сосудистым риском использова-ние ФК выгодно ввиду исходно низкой привержен-ности этих лиц к лечению [20,31,35] и высокой эффективности АГТ уже в первый месяц лечения [29].…”

Triple Combination Therapy in Hypertension: The Antihypertensive Efficacy of Treatment with Perindopril, Amlodipine, and Indapamide SR

“…69 treatment of hypertension appears beneficial in terms of BP 70 control and CV event reduction [8,9]. Combining two 71 antihypertensive agents from different classes has also 72 been shown to be a more effective way of reducing BP than 73 doubling the dose of a single agent [10].…”