Key result
Fixed-dose triple combination therapy achieves target BP in ~92% of previously uncontrolled hypertensive patients.
Why the study?
The study was conducted to identify patients with uncontrolled hypertension resistant to previous antihypertensive therapy and to assess the clinical efficacy of fixed-dose triple combination therapy.
Does fixed-dose triple combination therapy improve blood pressure control in patients with uncontrolled hypertension?
Cohort (n=156)
No
Does fixed-dose triple combination therapy improve blood pressure control in patients with uncontrolled hypertension?
Absolute Event Rate: 92.3% vs 0%
Supports consideration of fixed-dose triple therapy in uncontrolled hypertension; hypothesis-generating and requires randomized trials before practice change.
The aim of our study was to identify patients with uncontrolled hypertension (UCH) who were resistant to previous antihypertensive therapy (AHT) and to assess the clinical efficacy of the fixed-dose triple combination (FDTC) therapy during 6 months. Methods and Results: The study included 156 patients with UCH. The mean age of patients was 57.81±10.8 years; the average duration of AH was 8.87±5.34 years. According to the questionnaire data, all patients received dual or triple free-combination AHT, but did not reach the target blood pressure (BP) level. After the screening stage, all patients were discontinued from previous therapy and assigned to the FDTC therapy. Patients initially taking angiotensin-converting enzyme inhibitors (n=96/61.5%) were switched to single-pill triple combination (SPTC) of perindopril, indapamide and amlodipine (Per/Ind/Aml [5mg/1.25mg/5mg]). Patients initially taking angiotensin receptor blockers (n=60/38.5%) were switched to SPTC of telmisartan, hydrochlorothiazide and amlodipine (Tel/HCTZ/Aml [40mg/12.5mg/5mg]). The primary target level for SBP and DBP was <140mmHg and <90mmHg, respectively. With good tolerability of therapy, we aimed for the recommended target level of SBP/DBP (<130mmHg/<80 mmHg). All patients underwent the following examinations: assessment of traditional risk factors, physical examination, clinical and biochemical laboratory methods, 12-lead ECG, echocardiography, pulse contour analysis, and 24-hour ambulatory blood pressure monitoring. The results of our study showed that the FDTC therapy at the indicated initial doses in patients with UCT made it possible to achieve the primary target BP level in 73.7% of patients after 3 months of treatment. A further increase in SPTC doses made it possible to increase the number of patients (after 6 months of treatment)who achieved the primary goal to 92.3%, and the recommended goal in 82.4% of patients. After 6 months of treatment, against the background of selected doses of SPTC, 7.7% of patients were diagnosed with treatment-resistant hypertension. Conclusion: Markers of UCH are high SBP, DBP, and increased pulse wave velocity, which requires the maximum doses of a full-dose SPTC of antihypertensive drugs (Per/Ind/Aml or Tel/HCTZ/Aml), without wasting time on titration of drug doses.
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Masharipov et al. (2020) conducted a cohort in Uncontrolled arterial hypertension (n=156). Fixed-dose triple combination therapy (Perindopril/Indapamide/Amlodipine or Telmisartan/Hydrochlorothiazide/Amlodipine) vs. Baseline (previous free-combination therapy) was evaluated on Achievement of primary target blood pressure level (<140/90 mmHg) at 6 months. Fixed-dose triple combination therapy achieved the primary target blood pressure level (<140/90 mmHg) in 92.3% of patients with previously uncontrolled hypertension after 6 months of treatment.
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