Combination therapy in hypertension

Gradman, Alan H.; Basile, Jan; Carter, Barry L.; Bakris, George L.

doi:10.1016/j.jash.2010.02.005

Cited by 239 publications

(251 citation statements)

References 58 publications

Supporting

Mentioning

240

Contrasting

Unclassified

Order By: Relevance

“…The evidence from several trials11, 12 and observational analyses13 supports that starting a 2‐drug regimen (ie, “initial” combination therapy) rather than a single antihypertensive agent cannot only achieve more rapid and superior BP control,4 but may also lead to better cardiovascular outcomes 14. These prior studies demonstrated the benefits of initial combination therapy in a variety of regimens.…”

Section: Discussionmentioning

confidence: 98%

Prior Medications and the Cardiovascular Benefits From Combination Angiotensin‐Converting Enzyme Inhibition Plus Calcium Channel Blockade Among High‐Risk Hypertensive Patients

Brook

Kaciroti

Bakris

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundThe ACCOMPLISH (Avoiding Cardiovascular Events Through Combination Therapy in Patients Living with Systolic Hypertension) trial demonstrated that combination therapy using amlodipine, rather than hydrochlorothiazide, in conjunction with benazepril provided greater cardiovascular risk reduction among high‐risk hypertensive patients. Few trials have evaluated the effect of prior antihypertensive therapy used among participants on the study outcomes.Methods and ResultsIn a post hoc observational analysis, we examined the characteristics of the drug regimens taken before trial enrollment in the context of the primary composite outcome (death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, hospitalization for angina, resuscitation after sudden cardiac death, and coronary revascularization). In the “primary subgroup” (n=4475), patients previously taking any renin‐angiotensin system blockade plus either a diuretic or a calcium channel blocker alone or as part of their antihypertensive regimen, there were 206 of 2193 (9.4%) versus 281 of 2282 (12.3%) primary composite events among those randomized to combination therapy involving amlodipine versus hydrochlorothiazide, respectively (adjusted Cox proportional hazard ratio, 0.74; 95% confidence interval, 0.62–0.89; P=0.0015). All other participants (n=6975) previously taking any antihypertensive regimen not included in the primary subgroup also benefited from randomization to amlodipine plus benazepril (adjusted hazard ratio, 0.84; 95% confidence interval, 0.72–0.98; P=0.024). Outcomes among most other subgroups, including patients previously taking lipid‐lowering medications or dichotomized by prior blood pressure control status, showed similar results.ConclusionsWhen combined with an angiotensin‐converting enzyme inhibitor, amlodipine provides cardiovascular risk reduction superior to hydrochlorothiazide, largely regardless of prior medication use. These findings add further support for the initial use of this combination regimen among high‐risk hypertensive patients.

show abstract

Section: Discussionmentioning

confidence: 98%

Prior Medications and the Cardiovascular Benefits From Combination Angiotensin‐Converting Enzyme Inhibition Plus Calcium Channel Blockade Among High‐Risk Hypertensive Patients

Brook

Kaciroti

Bakris

et al. 2018

JAHA

View full text Add to dashboard Cite

show abstract

“…Single-pill combinations offer the possibility of better long-term adherence to treatment since this is strongly influenced by the number of medications and the frequency of dosing [25]. The use of combination therapy as the initial treatment in most patients diagnosed with hypertension is advocated by the American Society of Hypertension [26], while the European Society of Cardiology prefers to target patients with marked BP elevation and/or high cardiovascular risk [21]. …”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Fixed-Dose Perindopril Arginine/Amlodipine in Hypertensive Patients Not Adequately Controlled with Amlodipine 5 mg or Perindopril <b><i>tert</i></b>-Butylamine 4 mg Monotherapy

Sun

Liao³

et al. 2016

Cardiology

View full text Add to dashboard Cite

Objectives: To assess the blood pressure-lowering efficacy and tolerability of perindopril/amlodipine fixed-dose combinations in Chinese patients with mild-to-moderate essential hypertension not adequately controlled with monotherapy alone. Methods: In 2 separate double-blind studies, patients received a 4-week run-in monotherapy of amlodipine 5 mg or perindopril 4 mg, respectively. Those whose blood pressure was uncontrolled were then randomized to receive the fixed-dose combination of perindopril 5 mg/amlodipine 5 mg (Per/Amlo group) or remain on the monotherapy for 8 weeks. Patients who were uncontrolled at the week 8 (W8) visit were up-titrated for the Per/Amlo combination, or received additional treatment if on monotherapy, for a further 4 weeks. The main efficacy assessment was at 8 weeks. Results: After 8 weeks, systolic blood pressure (SBP; primary criterion) was statistically significantly lower in the Per/Amlo group (vs. Amlo 5 mg, p = 0.0095; vs. Per 4 mg, p < 0.0001). Uncontrolled patients at W8 who received an up-titration of the Per/Amlo combination showed a further SBP reduction. These changes were mirrored by reassuring reductions in diastolic blood pressure. The fixed-dose combinations were well tolerated. Conclusions: Single-pill combinations of perindopril and amlodipine provide hypertensive patients with a convenient and effective method of reducing blood pressure.

show abstract

“…Кроме того, следует обратить внимание на то, что на сегодняшний день около 25% пациентов с АГ нуж-даются в тройной комбинированной АГТ [7]. Это под-тверждается как международными рекомендациями [3], так и клиническими исследованиями, где боль-шинству больных требовалось назначение трех и более АГП для достижения целевого АД [8][9][10].…”

Section: Introductionunclassified

Triple Antihypertensive Therapy: Focus on Efficacy and Prognosis

Остроумова

Кочетков

Starodubova

et al. 2018

Racionalʹnaâ farmakoterapiâ v kardiologii

View full text Add to dashboard Cite

In the article, with regard to current clinical recommendations, the place of combined antihypertensive therapy, especially triple drugs regimens, is considered in the treatment of patients with arterial hypertension. Special focus is given to the body of evidence for the efficacy of valsartan and amlodipine, as the reference drug of angiotensin II receptor blockers and calcium channel blockers, respectively. Not only their high antihypertensive properties are demonstrated, but also a favorable effect on target-organ protection and prognosis is described. In particular, the possibilities of valsartan in reducing the severity of left ventricular hypertrophy and microalbuminuria are described, and its unique properties in the class of sartans that allow the use of this drug in patients with ischemic heart disease and chronic heart failure are emphasized. Data on the antiatherosclerotic effects of amlodipine and its proven ability to reduce cardiovascular risk are presented. Current data are presented about their use in a fixed-dose combination with hydrochlorothiazide, including real clinical practice settings. The evidence base of high clinical efficacy, safety and metabolic neutrality of the triple combination of antihypertensive drugs valsartan, amlodipine and hydrochorothiazide is presented. The issues of increasing adherence of patients to treatment when prescribing fixed-dose combinations are considered. An algorithm for the selection of antihypertensive drugs in the form of monotherapy and combination therapy of two or three drugs depending on the clinical situation (the presence of certain target-organs damages and associated clinical conditions, primarily ischemic heart disease, atherosclerosis of carotid arteries and chronic heart failure) and the severity of the additional risk of cardiovascular complications.

show abstract

Combination therapy in hypertension

Cited by 239 publications

References 58 publications

Prior Medications and the Cardiovascular Benefits From Combination Angiotensin‐Converting Enzyme Inhibition Plus Calcium Channel Blockade Among High‐Risk Hypertensive Patients

Prior Medications and the Cardiovascular Benefits From Combination Angiotensin‐Converting Enzyme Inhibition Plus Calcium Channel Blockade Among High‐Risk Hypertensive Patients

Efficacy and Safety of Fixed-Dose Perindopril Arginine/Amlodipine in Hypertensive Patients Not Adequately Controlled with Amlodipine 5 mg or Perindopril <b><i>tert</i></b>-Butylamine 4 mg Monotherapy

Triple Antihypertensive Therapy: Focus on Efficacy and Prognosis

Contact Info

Product

Resources

About