Blood Pressure Control by Drug Group in the Antihypertensive and Lipid‐Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)

Abstract

Blood pressure (BP) control rates and number of antihypertensive medications were compared (average follow-up, 4.9 years) by randomized groups: chlorthalidone, 12.5-25 mg ⁄ d (n=15,255), amlodipine 2.5-10 mg ⁄ d (n=9048), or lisinopril 10-40 mg ⁄ d (n=9054) in a randomized double-blind hypertension trial. Participants were hypertensives aged 55 or older with additional cardiovascular risk factor(s), recruited from 623 centers. Additional agents from other classes were added as needed to achieve BP control. BP was reduced from 145 ⁄ 83 mm Hg (27% control) to 134 ⁄ 76 mm Hg (chlorthalidone, 68% control), 135 ⁄ 75 mm Hg (amlodipine, 66% control), and 136 ⁄ 76 mm Hg (lisinopril, 61% control) by 5 years; the mean number of drugs prescribed was 1.9, 2.0, and 2.1, respectively. Only 28% (chlorthalidone), 24% (amlodipine), and 24% (lisinopril) were controlled on monotherapy. BP control was achieved in the majority of each randomized group-a greater proportion with chlorthalidone. Over time, providers and patients should expect multidrug therapy to achieve BP <140 ⁄ 90 mm Hg in a majority of patients. J Clin Hypertens (Greenwich). 2008;10:751-760.ª 2008 Le Jacq M ore than 70 million Americans-nearly 1 in 3 adults-have hypertension; its prevalence increases with age.

Treatment patterns of hypertension and dyslipidaemia in hypertensive patients at higher and lower risk of cardiovascular disease in primary care in the United Kingdom

“…Studies have emphasized the need to treat high-risk hypertensive patients with two or more antihypertensive agents. 36 The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High BP now recommends that in patients with BP 420/10 mm Hg above their BP goal, consideration should be given to initiating therapy with two antihypertensive agents; 31 likewise, the Joint British Societies' Guidelines on Prevention of CVD in Clinical Treatment of hypertensive patients with X3 additional risk factors TM MacDonald et al Practice (JBS2) recognize that antihypertensive monotherapy is insufficient in most patients with hypertension and that a combination of BP-lowering agents is needed. 37 In 2001, a large proportion of hypertensive patients, both with X3 ARFs or p2 ARFs, did not receive any antihypertensive medications.…”

Efficacy and safety of olmesartan medoxomil plus amlodipine in age, gender and hypertension severity defined subgroups of hypertensive patients

“…10 Clinical experience has shown that most hypertensive patients will require combination therapy with two or more antihypertensive drugs to achieve BP goals. [11][12][13] Hypertension treatment guidelines now place increasing emphasis on the benefits of initiating treatment with combination therapy, particularly in patients whose diastolic BP (DBP) or systolic BP (SBP) exceeds the goal by 410 mm Hg or 420 mm Hg, respectively. 7,8 Combining drugs from different classes is an effective way to increase antihypertensive power, and is recommended for drugs with complementary mechanisms of action, that is, where the combination produces a BP-lowering effect greater than that of either monotherapy component, and a favourable tolerability profile that reduces the frequency of undesirable effects.…”

Treatment of Risk Factors to Prevent Stroke

“…Another meta-analysis comparing diuretics to renin-angiotensin inhibitors in secondary stroke prevention concluded greater effect seen in diuretics than renin-angiotensin inhibitors [14]. However, before focusing on the idea that 1 drug class is superior to another, it is important to note that more 50% of persons with hypertension need more than 1 antihypertensive drug in clinical practice [20]. We should pay attention to reduction of BP itself before focusing on specific drug choice.…”