Effectiveness of two‐drug therapy versus monotherapy as initial regimen in hypertension: A propensity score‐matched cohort study in the UK Clinical Practice Research Datalink
Karine Marinier,Pauline Macouillard,Martine de Champvallins,Nicolas Deltour,Neil R Poulter,Giuseppe Mancia +5 more
TLDR
To compare the effectiveness on blood pressure of initial two‐drug therapy versus monotherapy in hypertensive patients, a large number of patients with high blood pressure were enrolled for initial treatment with two or more drugs.Abstract:
Purpose To compare the effectiveness on blood pressure (BP) of initial two-drug therapy versus monotherapy in hypertensive patients. Methods Using the Clinical Practice Research Datalink, linked with Hospital Episode Statistics and Office for National Statistics, we identified a cohort of adults with uncontrolled hypertension, initiating one or two antihypertensive drug classes between 2006 and 2014. New users of two drugs and monotherapy were matched 1:2 by propensity score. Main exposure was "as-treated," ie, until first regimen change. Primary and secondary endpoints were systolic and diastolic BP control and major adverse cardiovascular event (MACE), respectively. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox proportional hazard models. Results Of 54 523 eligible patients, 3256 (6.0%) were initiated to a two-drug combination. Of these, 2807 were matched to 5614 monotherapy users. Mean exposure duration was 12.7 months, with 76.5% patients changing their initial regimen. Two-drug therapy was associated with a clinically significant BP control increase in all hypertensive patients (HR = 1.17 [95%CI: 1.09-1.26]), more so in patients with grade 2-3 hypertension (HR = 1.28 [1.17-1.41]). An increase of 27% in BP control (HR = 1.27 [1.08-1.49]) was observed in patients initiating an ACEi+CCB combination compared with initiators of either single class. No significant association was found between two-drug therapy and MACE. Several sensitivity analyses confirmed the main findings. Conclusions Few patients initiated therapy with two drugs, reflecting UK guidelines' recommendation to start with monotherapy. This study supports the greater effectiveness of two-drug therapy as the initial regimen for BP control.read more
Citations
More filters
Journal ArticleDOI
Treatment Patterns and Blood Pressure Control With Initiation of Combination Versus Monotherapy Antihypertensive Regimens.
Jaejin An,Tiffany Q. Luong,Lei Qian,Rong Wei,Ran Liu,Paul Muntner,Jeffrey W. Brettler,Marc G. Jaffe,Andrew E. Moran,Kristi Reynolds +9 more
TL;DR: Patients who initiated ACEI-thiazide diuretic combination therapy were more likely to achieve BP <130/80 mm Hg compared with their counterparts who initiated monotherapy with ACEI.
Journal ArticleDOI
Big data and real-world data-based medicine in the management of hypertension
TL;DR: This article reviews hypertension-related papers that use big data or RWD and discusses on-going efforts to make use of RWD to generate RWE for regulatory decisions, as well as the challenges confronted.
Journal ArticleDOI
Hypertension as a risk factor for atherosclerosis: Cardiovascular risk assessment
Anastasia V. Poznyak,Nikolay K. Sadykhov,Andrey G. Kartuesov,E. Borisov,Alexandra A. Melnichenko,Andrey V. Grechko,Alexander N. Orekhov +6 more
TL;DR:
Journal ArticleDOI
Adherence to Treatment by Initial Antihypertensive Mono and Combination Therapies.
TL;DR: In this article, the authors compared adherence to antihypertensive drug therapy between newly treated patients in whom monotherapy or a 2-drug single-pill combination (SPC) was initially dispensed.
Journal ArticleDOI
Blood pressure control in Australian general practice: analysis using general practice records of 1.2 million patients from the MedicineInsight database.
Jacqueline Roseleur,Jacqueline Roseleur,David Alejandro González-Chica,Carla de Oliveira Bernardo,Benjamin P. Geisler,Benjamin P. Geisler,Benjamin P. Geisler,Jonathan Karnon,Nigel Stocks +8 more
TL;DR: Although the prevalence of hypertension varied by sociodemographic characteristics, there were no differences in BP assessment or control by socioeconomic status.
References
More filters
Journal ArticleDOI
2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).
Giuseppe Mancia,Robert Fagard,Krzysztof Narkiewicz,Josep Redon,Alberto Zanchetti,Michael Böhm,Thierry Christiaens,Renata Cifkova,Guy De Backer,Anna F. Dominiczak,Maurizio Galderisi,Diederick E. Grobbee,Tiny Jaarsma,Paulus Kirchhof,Sverre E. Kjeldsen,Stéphane Laurent,Athanasios J. Manolis,Peter M. Nilsson,Luis M. Ruilope,Roland E. Schmieder,Per Anton Sirnes,Peter Sleight,Margus Viigimaa,Bernard Waeber,Faiez Zannad,Michel Burnier,Ettore Ambrosioni,Mark Caufield,Antonio Coca,Michael H. Olsen,Costas Tsioufis,Philippe van de Borne,José Luis Zamorano,Stephan Achenbach,Helmut Baumgartner,Jeroen J. Bax,Héctor Bueno,Veronica Dean,Christi Deaton,Çetin Erol,Roberto Ferrari,David Hasdai,Arno W. Hoes,Juhani Knuuti,Philippe Kolh,Patrizio Lancellotti,Aleš Linhart,Petros Nihoyannopoulos,Massimo F Piepoli,Piotr Ponikowski,Juan Tamargo,Michal Tendera,Adam Torbicki,William Wijns,Stephan Windecker,Denis Clement,Thierry C. Gillebert,Enrico Agabiti Rosei,Stefan D. Anker,Johann Bauersachs,Jana Brguljan Hitij,Mark J. Caulfield,Marc De Buyzere,Sabina De Geest,Geneviève Derumeaux,Serap Erdine,Csaba Farsang,Christian Funck-Brentano,Vjekoslav Gerc,Giuseppe Germanò,Stephan Gielen,Herman Haller,Jens Jordan,Thomas Kahan,Michel Komajda,Dragan Lovic,Heiko Mahrholdt,Jan Östergren,Gianfranco Parati,Joep Perk,Jorge Polónia,Bogdan A. Popescu,Zeljko Reiner,Lars Rydén,Yuriy Sirenko,Alice Stanton,Harry A.J. Struijker-Boudier,Charalambos Vlachopoulos,Massimo Volpe,David A. Wood +89 more
TL;DR: In this article, a randomized controlled trial of Aliskiren in the Prevention of Major Cardiovascular Events in Elderly people was presented. But the authors did not discuss the effect of the combination therapy in patients living with systolic hypertension.
Journal ArticleDOI
Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies.
TL;DR: Throughout middle and old age, usual blood pressure is strongly and directly related to vascular (and overall) mortality, without any evidence of a threshold down to at least 115/75 mm Hg.
Journal ArticleDOI
2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8)
Paul A. James,Suzanne Oparil,Barry L. Carter,William C. Cushman,Cheryl Dennison-Himmelfarb,Joel Handler,Daniel T. Lackland,Michael L. LeFevre,Thomas D. MacKenzie,Olugbenga Ogedegbe,Sidney C. Smith,Laura P. Svetkey,Sandra J. Taler,Raymond R. Townsend,Jackson T. Wright,Andrew S. Narva,Eduardo Ortiz +16 more
TL;DR: Although this guideline provides evidence-based recommendations for the management of high BP and should meet the clinical needs of most patients, these recommendations are not a substitute for clinical judgment, and decisions about care must carefully consider and incorporate the clinical characteristics and circumstances of each individual patient.
Journal ArticleDOI
2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)
Giuseppe Mancia,Robert Fagard,Krzysztof Narkiewicz,Josep Redon,Alberto Zanchetti,Michael Böhm,Thierry Christiaens,Renata Cifkova,Guy De Backer,Anna Dominiczak,Maurizio Galderisi,Diederick E. Grobbee,Tiny Jaarsma,Paulus Kirchhof,Sverre E. Kjeldsen,Stephane Laurent,Athanasios J. Manolis,Peter M. Nilsson,Luis M. Ruilope,Roland E. Schmieder,Per Anton Sirnes,Peter Sleight,Margus Viigimaa,Bernard Waeber,Faiez Zannad +24 more
TL;DR: 2007 Guidelines for the Management of Arterial Hypertension : The Task Force for the management of Arterspertension of the European Society ofhypertension (ESH) and of theEuropean Society of Cardiology (ESC).
Journal ArticleDOI
2018 ESC/ESH Guidelines for the management of arterial hypertension.
B. Williams,G. Mancia,Wilko Spiering,Agabiti Rosei E,M. Azizi,Michel Burnier,Denis Clement,A. Coca,de Simone G,A Dominiczak,T. Kahan,Felix Mahfoud,Josep Redon,L.M. Ruilope,Alberto Zanchetti,Mary Kerins,S.E. Kjeldsen,Reinhold Kreutz,S. Laurent,Lip Gyh.,Richard J McManus,Krzysztof Narkiewicz,Frank Ruschitzka,R.E. Schmieder,Evgeny Shlyakhto,Constantinos Tsioufis,Aboyans,Ileana Desormais +27 more