Monotherapy Versus Double-Agent Combination Therapy as a First-Line Treatment for Hypertensive Adults: A Cross-Sectional Study

Objective: Worldwide, an estimated 1.28 billion adults between the ages of 30 and 79 suffer from hypertension. Only 42% of them are diagnosed and receive treatment. Hypertension is considered to be a major cause of premature death. WHO guidelines for hypertensive adults requiring pharmacological treatment suggest an initial therapy with a single-agent, while double-agent combination therapy is considered preferable when target blood pressure is not reached with a single-agent treatment. Design and method: The present study included 2000 patients, divided by gender, randomly selected with up to Grade II Hypertension, who attended consultations in the out-patient clinic of Hypertension in the General Hospital of Thessaloniki “G. Papanikolaou” between February 2018 and December 2023. The exclusion criteria included patients with secondary causes of hypertension. The patients were divided in two equal groups according to their treatment plan: Monotherapy group and Combination group. Results: In total, 693(34.6%) of patients, both men and women, with no comorbidities other than hyperlipidemia or hypothyroidism, followed the same treatment plan using a single agent treatment and achieved the target levels of blood pressure. It is imperative to point out that these patients had no signs of atherosclerosis by carotid ultrasound. On the contrary, patients with medical history of diabetes mellitus, obesity, cancer, stroke, intracranial bleeding, aneurysm and coronary artery disease, required combined treatment with two drugs or more to reach the acceptable Blood Pressure levels. There was no statistical significance between men and women. Conclusions: This study demonstrates that patients with hypertension can be treated with monotherapy and reach the target Blood Pressure levels only when no comorbidities exist. When atherosclerosis exists being the cause of many of the forementioned comorbidities, a combination double-agent drug is necessary.