Single-Pill Combination Antihypertensive Therapy in Hypertensive, Obese Patients: A Prospective, Epidemiological Study in Romania

Objective: To assess the blood pressure (BP) management in obese, hypertensive patients under treatment with single-pill combination (SPC) antihypertensive therapy. Design and method: Prospective, observational, multicenter study, involving 192 investigators (85 cardiologists and 107 general practitioners) randomly selected from Romanian healthcare system, which included 1299 obese, hypertensive patients (Body Mass Index (BMI) of 30 kg/m2 or higher); 56.22±11years; 53.89% females) (1-month recruitment). The total study duration was 5 months (May-Aug 2023), while the patient observational period was 12 weeks (including 3 visits: baseline, at one month and at three months after inclusion). At enrolment visit each patient received a SPC antihypertensive therapy as per investigator’s decision, based on his/her own best medical judgement and in line with the current practice guidelines. Demographic data, comorbidities and data regarding hypertension and evolution of BP values in relation to the antihypertensive treatments were collected. Results: The study population had the following characteristics: BMI 34.35±4.21 kg/m2; 20.94% smokers, 56.81% with CV family history, and 52.12% had comorbidities. Among the patients with comorbidities the most frequently identified were diabetes mellitus type 2 (37.37%), valvular heart disease (20.97%), angina (19.35%) and heart failure (16.24%). At study inclusion the investigators’ perception regarding the cardiovascular (CV) risk was that only 27.02% of patients are in “very high” risk category, while according to SCORE2 and SCORE2-OP the actual calculated CV “very high” risk, was identified in 68.82% of patients. The most frequent recommended double SPC at study inclusion were perindopril/indapamide (81.68%) and olmesartan/amlodipine (5%). Hypertension was treated in all patients and systolic and diastolic BP values (SBP and DBP) and heart rate (HR) decreased significantly throughout the study (p<0.001) (Fig. 1). Analyzing the patients treated with different double SPC a significant decrease in BP and HR values was observed (p<0.001) for the perindopril/indapamide SPC, and olmesartan/amlodipine, respectively (Fig. 2). Conclusions: This study showed that single pill antihypertensive combinations are effective in decreasing BP and HR values in hypertensive obese patients, while correct CV risk estimation by clinicians remains challenging in their daily practice, with the tendency of underestimation.