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First Line CombinAtion Therapy in the Treatment of Stage II and III Hypertension (FLASH)

David Spirk1, Sarah Noll2, Michel Burnier3

  • 1Institute of Pharmacology, University of Bern, Bern, Switzerland.

Frontiers in Cardiovascular Medicine
|April 16, 2020
PubMed

Insights

Single-pill irbesartan/hydrochlorothiazide effectively lowers blood pressure (BP) in hypertensive patients. This combination therapy showed better systolic BP control when used as a first-line treatment compared to replacement therapy.

Area of Science:

  • Cardiology
  • Pharmacology
  • Hypertension Management

Background:

  • Lowering blood pressure (BP) is crucial for reducing cardiovascular events.
  • Single-pill combination therapies offer potential advantages over monotherapy dose escalation or separate drug use for BP control.

Purpose of the Study:

  • To evaluate the real-world effectiveness of first-line or replacement single-pill combination therapy with irbesartan and hydrochlorothiazide (HCTZ).
  • To assess the systolic blood pressure (SBP) control rate in hypertensive patients using this combination.

Main Methods:

  • An observational, prospective, nationwide cohort study (FLASH) included 780 patients with moderate to severe hypertension.
  • Patients received irbesartan/HCTZ single-pill combination therapy, with BP measured at baseline and 8-week follow-up.

Main Results:

  • Mean SBP/DBP reductions were 23.7/11.7 mmHg. First-line treatment yielded greater SBP/DBP reductions (26.9/13.0 mmHg) than replacement therapy (21.8/11.0 mmHg).
  • Guideline-recommended BP goals were achieved in 47% for SBP, 63% for DBP, and 40% for both. SBP control rate was significantly higher with first-line use (52% vs. 44%).
  • The combination was well-tolerated, with adverse events including hypotension (1.5%) and hypokalemia (1.2%).

Conclusions:

  • Single-pill irbesartan/HCTZ is well-tolerated and effectively reduces both systolic and diastolic BP.
  • Prescribing irbesartan/HCTZ as first-line therapy resulted in a higher SBP control rate, aligning with current hypertension guidelines.

Keywords:
blood pressuregoal attainmenthydrochlorothiazidehypertensionsingle-pill combination therapy

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