Comparison of single-pill strategies first line in hypertension
| Autor: | Celso Amodeo, Marco Antonio Alcocer Gamba, Irina Chazova, Jean-Jacques Mourad, Juan G. Puig, Stefano Taddei, Roland Asmar, Giuseppe Mancia |
|---|---|
| Přispěvatelé: | Mancia, G, Asmar, R, Amodeo, C, Mourad, J, Taddei, S, Gamba, M, Chazova, I, Puig, J |
| Rok vydání: | 2015 |
| Předmět: |
singlepill combination
Adult Male medicine.medical_specialty hypertension Physiology First line Blood Pressure amlodipine perindopril valsartan Internal Medicine Cardiology and Cardiovascular Medicine law.invention Double-Blind Method Randomized controlled trial law Drug Combination Internal medicine Perindopril medicine Amlodipine Aged business.industry Indapamide Middle Aged Amlodipine Valsartan Drug Combination Antihypertensive Agent Blood pressure Valsartan Pill Cardiology Drug Therapy Combination Female business Human medicine.drug |
| Zdroj: | Journal of Hypertension. 33:401-411 |
| ISSN: | 0263-6352 |
| DOI: | 10.1097/hjh.0000000000000409 |
| Popis: | Objectives: An international double-blind, parallel-group, randomized controlled trial was performed to determine the efficacy and safety of a new first-line strategy in mild to moderate hypertension based on a single-pill combination of perindopril/amlodipine versus a validated stepped-care strategy (initiation with valsartan monotherapy, up-titrating to valsartan/amlodipine after 2 months). Methods: At inclusion, patients received perindopril/amlodipine 3.5/2.5 mg or valsartan 80 mg. At 1, 2, and 3 months, patients were up-titrated if they had uncontrolled hypertension (≥140/90 mmHg). The up-titration steps were: perindopril/amlodipine 7/5 mg, 14/10 mg, and 14/10 mg + indapamide sustained release 1.5 mg; or valsartan 160 mg, valsartan/amlodipine 160/5 mg, and 160/10 mg. The two groups were similar at baseline (55.5 years, 53% men, blood pressure 163.5/100.2 mmHg); 881 perindopril/amlodipine and 876 valsartan/amlodipine patients were analyzed for efficacy. Results: After 1 month, the rate of controlled hypertension was 33% with perindopril/amlodipine versus 27% with valsartan/amlodipine (estimate of difference, +6.1%; P = 0.005); this between-strategy difference remained significant at every visit (P < 0.05). After 3 months, blood pressure was 137.8 ± 12.4/83.3 ± 8.7 and 139.7 ± 13.3/84.8 ± 9.0 mmHg, respectively, with greater reductions from baseline with perindopril/amlodipine (primary endpoint -2.0/-1.5 mmHg; both P < 0.001). Similar results were observed at all other visits (all P ≤ 0.001). The safety of the two strategies was equivalent. CONCLUSIONS: The three-step strategy of initiation with single-pill perindopril/amlodipine produces greater reductions in blood pressure, and better and quicker rates of control of hypertension. This can be expected to be associated with benefits beyond blood pressure control, notably improved compliance and better cardioprotection. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|