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Benefit of initial dual-therapy on stroke prevention in Chinese hypertensive patients: a real world cohort study
Jin-Ming Yu1, Qun-Yu Kong1, Tian Shen1
11 Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China ; 2 Medical Affairs of Great China Region of Novartis, Shanghai 201101, China ; 3 Shanghai Minhang Center for Disease Control and Prevention, Shanghai 201101, China.
Insights
Initial dual-therapy for hypertension significantly reduced stroke risk within the first six months compared to monotherapy in Chinese patients. However, this early benefit did not persist long-term, suggesting combination therapy is beneficial for early stroke prevention.
Area of Science:
- Cardiovascular Medicine
- Hypertension Research
- Stroke Prevention
Background:
- Combination antihypertensive therapy generally outperforms monotherapy for blood pressure control and cardiovascular event prevention.
- The specific benefit of combination therapy in preventing stroke among Chinese hypertensive patients remains under investigation.
Purpose of the Study:
- To compare the effectiveness of initial dual-combination versus monotherapy in preventing stroke events in a large cohort of Chinese hypertensive patients.
Main Methods:
- A cohort of Chinese hypertensive patients without prior stroke and uncontrolled blood pressure was divided into initial monotherapy and dual combination groups.
- Patients were followed for 42 months, with blood pressure control rates and stroke incidence density recorded at multiple time points.
Main Results:
- The dual-therapy group showed a significantly lower incidence of stroke within the first 6 months (adjusted HR 0.64).
- Blood pressure control rates were similar between groups throughout the 42-month follow-up.
- No significant differences in stroke incidence density were observed between the groups at 12, 24, and 42 months.
Conclusions:
- Initial dual-combination antihypertensive therapy is more effective than monotherapy for early stroke prevention within the first six months in Chinese patients with uncontrolled hypertension.
- The long-term stroke prevention advantage of initial dual therapy was not sustained beyond six months.
Aims:
Studies have shown that combination anti-hypertensive therapy is superior to mono-therapy in blood pressure control and prevention of cardiovascular events. However, whether such advantage exists in the prevention of stroke in Chinese hypertensive patients remains unclear. This study aimed to compare the impact of initial combination versus mono-therapy on stroke events in a large cohort of Chinese hypertensive patients.
Methods And Results:
Hypertensive patients with uncontrolled blood pressure and without a history of stroke were screened from the Shanghai Community-dwelling Hypertensive Population Follow-up Database. Based on the initial treatment, individuals were divided into an initial mono-therapy group and initial dual combination group. Patients were followed for 42 months. 32,682 and 4,926 patients were included in the initial mono- and dual-therapy group. The achieved target blood pressure control rates of mono vs. combination groups at 6, 12, 24, and 42 months of follow-up, were 59.47% vs. 60.05%, 78.23% vs. 77.06%, 85.51% vs. 84.02%, and 86.90% vs. 85.44%, respectively. Their corresponding incidence densities of stroke were 0.792 vs. 0.489, 1.49 vs. 1.15, 2.79 vs. 2.38, and 4.25 vs. 4.32 (cases per 100 person-year), respectively. The 6-month incidence of stroke in dual-therapy group was significantly lower than mono-therapy group (adjusted HR 0.64; 95% CI: 0.30-0.93). However, no significant group differences in the incidence density were observed at 12, 24, and 42 months.
Conclusions:
Our study demonstrates that, for patients with uncontrolled hypertension, initial dual therapy is more effective in the prevention of stroke during the first 6 months of treatment, but not thereafter. Combination antihypertensive therapy may be a beneficial initial strategy for early stroke prevention.