Managing hypertension: a question of STRATHE

Area of Science:

• Cardiology
• Pharmacology
• Clinical Trials

Background:

• Current hypertension guidelines recommend therapeutic strategies to achieve blood pressure < 140/90 mmHg.
• Three strategies are endorsed post-lifestyle intervention: low-dose combination, sequential monotherapy, and stepped care.
• The STRATHE study aimed to compare these strategies for uncomplicated essential hypertension.

Purpose of the Study:

• To compare the efficacy and tolerability of three distinct hypertension management strategies.
• To evaluate blood pressure normalization rates and adverse events associated with each strategy.
• To provide evidence supporting optimal antihypertensive treatment approaches.

Main Methods:

• The Strategies of Treatment in Hypertension: Evaluation (STRATHE) study enrolled 533 patients with uncomplicated essential hypertension.
• Patients were randomized into three groups: low-dose combination, sequential monotherapy, or stepped care.
• Efficacy (blood pressure normalization) and tolerability (adverse events) were assessed for each strategy.

Main Results:

• The low-dose combination strategy achieved normalization in 62% of patients, significantly higher than sequential monotherapy (49%) and stepped care (47%).
• Normalization without adverse events was also significantly higher in the low-dose combination group (56%) compared to sequential monotherapy (42%) and stepped care (42%).
• These findings suggest improved acceptability with reduced dosages in combination therapies.

Conclusions:

• A low-dose combination of antihypertensive agents is a superior strategy for managing hypertension compared to sequential monotherapy or stepped care.
• The combination of perindopril (2 mg) and indapamide (0.625 mg) demonstrated significant efficacy and tolerability.
• This study supports the use of low-dose combination therapy as a primary treatment for uncomplicated essential hypertension.