Related Experiment Videos
How can hypertensive patients be better treated? The contribution of combination therapy
A Benetos1, L Guize, A Rudnichi
1INSERM U337 and Centre d'Investigations Préventives et Cliniques, Paris, France.
Insights
Hypertension management in France shows low treatment and control rates, with most patients having modifiable risk factors. Combination therapies, like trandolapril-verapamil, may improve blood pressure control.
Area of Science:
- Cardiology
- Public Health
- Pharmacology
Background:
- Target blood pressure for treated hypertensive patients is <140/90 mmHg.
- Clinical practice shows less than 30% of hypertensive patients achieve controlled blood pressure.
- A significant proportion of hypertensive individuals have modifiable cardiovascular risk factors.
Purpose of the Study:
- To analyze hypertension treatment and control rates in a large French population.
- To identify the prevalence of cardiovascular risk factors in hypertensive patients.
- To evaluate the potential of combination therapies for improving blood pressure control.
Main Methods:
- Analysis of 145,000 subjects from the Centre d'Investigations Préventives et Cliniques (IPC) in Paris.
- Examination of antihypertensive treatment rates and blood pressure control levels.
- Assessment of associated cardiovascular risk factors in hypertensive patients.
Main Results:
- Only 20% of individuals with high blood pressure received treatment.
- Less than 27% of treated patients achieved target blood pressure (<140/90 mmHg).
- 72% of hypertensive patients had at least one modifiable cardiovascular risk factor; over 30% had two or more.
Conclusions:
- Hypertension control remains suboptimal in France, with low treatment and control rates.
- Combination therapies, such as trandolapril-verapamil, are recommended to improve blood pressure control in a majority of treated subjects.
- The trandolapril-verapamil combination demonstrates effective blood pressure reduction and beneficial effects on heart rate without adverse metabolic impact.
Abstract:
Recent studies demonstrated that target blood pressure (BP) in treated hypertensive patients should be below 140 mmHg for systolic blood pressure (SBP) and below 90 mmHg for diastolic blood pressure (DBP). However, population studies from several countries have demonstrated that in clinical practice the proportion of controlled hypertensive patients is less than 30%. In order to elucidate these questions in France we analysed a large population of 145,000 subjects examined at the Centre d'Investigations Préventives et Cliniques in Paris (IPC). Among those with high BP at the time of their IPC visit, only 20% received an antihypertensive treatment. Among those receiving an antihypertensive treatment, less than 27% (24% in men and 30% in women) presented with BP values less than 140 mmHg for SBP and less than 90 mmHg for DBP. This analysis also showed that 72% of hypertensive patients presented with at least one modifiable associated cardiovascular risk factor and that more than 30% of hypertensive men and more than 25% of hypertensive women presented with at least two associated risk factors. The use of combination therapies could help to increase the percentage of well-controlled hypertensive subjects. It has been shown that in order to reach this BP level, combination therapy should be used in more than two-thirds of the treated subjects. The trandolapril-verapamil combination is the first fixed combination of an angiotensin-converting enzyme inhibitor and a non-dihydropyridine calcium-channel blocker. Administered once daily, this combination reduces BP more than a classic monotherapy. The effects of the trandolapril-verapamil combination on risk factors are either neutral (metabolic parameters), or even beneficial (reduction in heart rate).