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Initial combination therapy reduces the risk of cardiovascular events in hypertensive patients: a matched cohort

Alan H Gradman1, Hélène Parisé, Patrick Lefebvre

  • 1Temple University School of Medicine, 1239 Shady Ave, Pittsburgh, PA 15232, USA. gradmana@temple.edu

Hypertension (Dallas, Tex. : 1979)
|November 28, 2012
PubMed

Insights

Starting combination therapy for hypertension early significantly reduces cardiovascular events. Rapidly achieving target blood pressure is key to this risk reduction, improving patient outcomes.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Time to blood pressure (BP) control impacts long-term cardiovascular (CV) outcomes in hypertension.
  • Real-world evidence on initial versus delayed combination therapy for hypertension is limited.

Purpose of the Study:

  • To evaluate the impact of initial versus delayed combination therapy on BP control and CV event risk in hypertensive patients.
  • To assess the association between rapid BP control and reduced CV event risk.

Main Methods:

  • Retrospective analysis of 1762 adult hypertensive patients using electronic medical charts (2005-2009).
  • Comparison of patients initiating immediate combination therapy versus those initially on monotherapy then switched.
  • Utilized incidence rate ratios, Kaplan-Meier analysis, and time-varying Cox proportional hazard models.

Main Results:

  • Initial combination therapy significantly reduced the risk of CV events or death by 34% (IRR, 0.66; P=0.0008).
  • 40.3% of patients on initial combination therapy achieved BP control within 6 months versus 32.6% on delayed therapy.
  • Achieving target BP significantly reduced CV event/death risk by 23% (HR, 0.77; P=0.0223).

Conclusions:

  • Initial combination therapy for hypertension is associated with a significant reduction in cardiovascular events.
  • Faster achievement of target blood pressure is the primary driver of the observed risk reduction with early combination therapy.

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