Key result
Amlodipine plus telmisartan dual therapy is linked to a ~29 mm Hg SBP reduction versus monotherapy.
Why the study?
Hypertension often requires two or more antihypertensive drugs for optimal blood pressure control, but the comparative effectiveness, cost, and adherence of monotherapy versus combination therapy in stage-1 hypertension need evaluation.
Does combination antihypertensive therapy improve blood pressure reduction compared to monotherapy in patients with stage-1 hypertension?
Observational (n=200)
Does combination antihypertensive therapy improve blood pressure reduction compared to monotherapy in patients with stage-1 hypertension?
Dual antihypertensive therapy provides greater blood pressure reduction than monotherapy in stage-1 hypertension, but high rates of medication non-adherence highlight the need for multidisciplinary patient engagement.
Dual therapy was associated with greater BP reduction in stage-1 hypertension; high non-adherence leaves open real-world effectiveness and warrants adherence trials.
Hypertension has multiple pathogenesis and majority of patients require two or more antihypertensive drugs to provide optimum control of blood pressure. The aim is to compare the effectiveness of mono therapy versus combination therapy in patients with stage-1 hypertension, to assess the medication adherence and to compare the cost incurred per day for the different therapies. Patient’s demographical details and history was recorded in a data entry form. Outcome of the treatment was measured in terms of reduction in systolic and diastolic blood pressure. Patient’s medication adherence was assessed using modified Medication Adherence Scale. Economic outcomes were measured in terms of cost of individual therapy. The data was entered into the excel sheet and statistically analysed using ANOVA. Results showed that dual therapy is the most effective in reducing the mean systolic (28.75 mm Hg) and diastolic (8.875) blood pressure with the combination of Amlodipine + Telmisartan being the most effective. Here, 66 patients (33%) were found to be adherent and 134 patients (67%) were found to be non- adherent. It was found that AMLOKIND 2.5, LOSAKIND and ATEN 50 were the most cost effective brands of drug from the classes of calcium channel blockers, angiotensin receptor blockers and beta blockers respectively. Comparison of effectiveness of various antihypertensive therapies showed that dual therapy shows maximum reduction in mean systolic BP and thus it can be prescribed more often in Stage I hypertensive patients. The poor adherence scores indicate that a multidisciplinary approach with a greater involvement of the patient is required to increase the compliance of the patient. Also cost effective drugs need to be prescribed more in order to decrease the financial burden on the patients.
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Mathew et al. (2018) conducted an observational in Stage-1 hypertension (n=200). Combination therapy (dual therapy) vs. Monotherapy was evaluated on Reduction in systolic and diastolic blood pressure. Dual therapy, particularly Amlodipine plus Telmisartan, was most effective in reducing mean systolic (28.75 mm Hg) and diastolic (8.875 mm Hg) blood pressure compared to monotherapy.
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