Related Experiment Video
Updated: May 21, 2025
Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
Published on: May 26, 2022
Long-term event rates, risk factors, and treatment pattern in 1.4 million individuals qualifying for dual blood
Antonio Coca1, Claudio Borghi2, George S Stergiou3
1School of Health and Life Sciences, Universitat Abat Oliba, CEU Universities, Barcelona, Spain.
Insights
Dual blood pressure therapy significantly reduced cardiovascular events compared to monotherapy. Despite this, monotherapy remains the most common treatment, highlighting a missed opportunity for risk reduction.
Area of Science:
- Cardiology
- Hypertension Management
- Public Health
Background:
- Dual combination blood pressure (BP)-lowering therapy is indicated for many patients.
- Understanding treatment patterns and outcomes in this population is crucial for optimizing cardiovascular risk reduction.
Purpose of the Study:
- To assess cardiovascular event rates, all-cause death, risk factors, and treatment patterns in patients eligible for dual BP-lowering therapy.
- To evaluate the association between dual therapy versus monotherapy and cardiovascular event incidence.
Main Methods:
- Utilized integrated English databases (CPRD, HES, ONS) from 2005-2019.
- Identified 1,426,079 individuals eligible for dual therapy.
- Primary endpoint: composite of nonfatal MI, nonfatal stroke, HF hospitalization, CV death. Secondary endpoint: all-cause death.
Main Results:
- 15-year event rates for primary and secondary endpoints were 27.1% and 32.6%.
- High-risk factors (ASCVD, diabetes, HF, AF, CKD, age) increased event risk 2-4 fold.
- Dual therapy showed a hazard ratio of 0.82 (95% CI 0.81-0.83) for the primary endpoint versus monotherapy.
- Monotherapy was the most common treatment over 5-year follow-up, contrary to guidelines.
Conclusions:
- High-risk factors for cardiovascular events and death are often nonmodifiable.
- Dual therapy significantly reduced cardiovascular events compared to monotherapy.
- Suboptimal use of monotherapy presents a significant opportunity for risk reduction through treatment intensification.
Objectives:
We assessed rates of cardiovascular events, all-cause death, baseline risk factors, and treatment patterns in a population qualifying for initiation of dual combination blood pressure (BP)-lowering therapy. We also evaluated the association between dual versus monotherapy during follow-up and incidence of cardiovascular events.
Methods:
This study utilized integrated databases in England: Clinical Practice Research Datalink, Hospital Episode Statistics, and Office for National Statistics. Individuals aged at least 18 years qualifying for dual therapy were identified during 15-year period (2005-2019). The primary endpoint was composite of nonfatal myocardial infarction, nonfatal stroke, hospitalization for heart failure, and cardiovascular death. The secondary endpoint was all-cause death.
Results:
Total 1 426 079 individuals met selection criteria. The 15-year event rates for the primary and secondary endpoints were 27.1 and 32.6%, respectively. Atherosclerotic cardiovascular disease, diabetes on insulin therapy, heart failure, atrial fibrillation, chronic kidney disease, and advanced age were associated with two to four-fold higher risk of primary and secondary endpoints. The estimated hazard ratio for dual versus monotherapy as a time-varying covariate was 0.82 (95% confidence interval 0.81-0.83) for the primary endpoint. At variance with guidelines, monotherapy was most common treatment pattern over 5-year follow-up.
Conclusion:
Baseline characteristics conveying a multifold higher risk for cardiovascular events and all-cause death mostly represented nonmodifiable risk factors. Treatment with dual therapy as compared to monotherapy was associated with reduction in cardiovascular events. Monotherapy remained most common BP-lowering treatment indicating substantial opportunity for risk reduction by treatment intensification.
Related Concept Videos
01:28Factors affecting Blood pressure
Physiological Factors:
01:18Hypertension and Regulation of Blood Pressure
01:30Alterations in Blood Pressure
Hypertension (High blood pressure)
Hypertension occurs when blood pressure readings consistently exceed the normal range. It is diagnosed when systolic blood pressure (the top number, indicating pressure while the heart...
01:25Errors occurring during blood pressure monitoring
Several factors...
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
00:59Model-Independent Approaches for Pharmacokinetic Data: Noncompartmental Analysis
One important characteristic of noncompartmental analyses is that drug exposure increases proportionally with increasing doses. This...