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Always Initiate combination therapy for patients with BP >150/95 mm Hg

Always Initiate combination therapy for patients with BP >150/95 mm Hg

In a Double‐Blind Randomized Controlled Trial, it has been found that Combination Therapy Is Superior to Sequential Monotherapy for the Initial Treatment of Hypertension.The results of the Trial have been published in Journal of the American Heart Association.

As Guidelines for hypertension vary in their preference for initial combination therapy or initial monotherapy, stratified by patient profile; therefore Dr. Thomas M. MacDonald and associates compared the efficacy and tolerability of these approaches.

The researchers performed a 1‐year, double‐blind, randomized controlled trial in 605 untreated patients aged 18 to 79 years with systolic blood pressure (BP) ≥150 mm Hg or diastolic BP ≥95 mm Hg. In phase 1 (weeks 0–16), patients were randomly assigned to initial monotherapy (losartan 50–100 mg or hydrochlorothiazide 12.5–25 mg crossing over at 8 weeks), or initial combination (losartan 50–100 mg plus hydrochlorothiazide 12.5–25 mg). In phase 2 (weeks 17–32), all patients received losartan 100 mg and hydrochlorothiazide 12.5 to 25 mg. In phase 3 (weeks 33–52), amlodipine with or without doxazosin could be added to achieve target BP. Hierarchical primary outcomes were the difference from baseline in-home systolic BP, averaged over phases 1 and 2 and, if significant, at 32 weeks. Secondary outcomes included adverse events and difference in home systolic BP responses between tertiles of plasma renin.

It was found that home systolic BP after initial monotherapy fell 4.9 mm Hg (range: 3.7–6.0 mm Hg) less over 32 weeks (P<0.001) than after initial combination but caught up at 32 weeks (difference 1.2 mm Hg [range: −0.4 to 2.8 mm Hg], P=0.13). In phase 1, home systolic BP response to each monotherapy differed substantially between renin tertiles, whereas the response to combination therapy was uniform and at least 5 mm Hg more than to monotherapy. There were no differences in withdrawals due to adverse events.

The authors concluded that  Initial combination therapy can be recommended for patients with BP >150/95 mm Hg.

For more details click on the link:  http://www.ClinicalTrials.gov. Unique identifier: NCT00994617.

Source: self

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