[Control of blood pressure in hypertensive patients on combination therapy]

Area of Science:

• Cardiology
• Pharmacology
• Nephrology

Context:

• Hypertension management remains a challenge, with limited understanding of treatment efficacy.
• Optimizing blood pressure (BP) control in patients on multiple antihypertensive agents is crucial for reducing cardiovascular risk.
• Referral units manage complex hypertensive cases, necessitating evaluation of treatment strategies.

Purpose:

• To assess blood pressure (BP) control rates in hypertensive patients receiving two or three antihypertensive agents.
• To identify factors associated with BP control, including patient demographics and treatment regimens.
• To evaluate the impact of fixed-drug combinations versus separate administration on BP control.

Summary:

• A study of 1,337 hypertensive patients (mean age 63 years) on 2-3 antihypertensive drugs found 57% achieved BP control (<140/90mmHg).
• Lack of BP control was associated with older age (12% increased risk per decade) and microalbuminuria (64% increased risk).
• For patients on three agents, fixed-drug combinations (68% control) showed better BP control than separate administration (52% control; P=.025).

Impact:

• Findings highlight the prevalence of suboptimal BP control in patients on complex antihypertensive regimens.
• Identifies microalbuminuria as a significant barrier to achieving BP targets, suggesting closer monitoring.
• Supports the use of fixed-drug combinations for three-agent therapy to enhance blood pressure management and patient outcomes.