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Monotherapy Blood Pressure Response and Control Rates in Treatment-Naïve Patients with Arterial Hypertension: A
Insights
Initial antihypertensive monotherapy with perindopril, olmesartan, amlodipine, or hydrochlorothiazide showed varying efficacy. Renin-angiotensin-aldosterone system inhibitors demonstrated superior blood pressure control compared to hydrochlorothiazide, supporting combination therapy.
Area of Science:
- Cardiology
- Pharmacology
- Hypertension Management
Background:
- Previous guidelines recommended four antihypertensive drug classes equally for initial treatment.
- The comparative efficacy of these drug classes in achieving blood pressure control remained unclear.
- This study aimed to compare response rates and blood pressure control among four first-line antihypertensive drug classes.
Purpose of the Study:
- To compare the efficacy of perindopril, olmesartan, amlodipine, and hydrochlorothiazide in achieving blood pressure control.
- To evaluate response rates and blood pressure reduction in patients with newly diagnosed hypertension.
Main Methods:
- Randomized trial of 88 patients with mild to moderate hypertension using 24-h ambulatory blood pressure monitoring (ABPM).
- Patients were assigned to perindopril, olmesartan, amlodipine, or hydrochlorothiazide (HCT).
- Dosage adjustments were made based on ABPM readings at 4 and 8 weeks to assess blood pressure control.
Main Results:
- Olmesartan showed the highest blood pressure reduction (-15/-10 mm Hg), while HCT showed the lowest (-8/-1 mm Hg).
- Only 27% of patients achieved systolic-diastolic blood pressure control; perindopril and olmesartan had the highest control rates (40% and 39%).
- Hydrochlorothiazide demonstrated the lowest blood pressure control rate (5%).
Conclusions:
- Initial antihypertensive monotherapy was insufficient for most patients, with significant variation in efficacy among drug classes.
- Inhibitors of the renin-angiotensin-aldosterone system (perindopril, olmesartan) were more effective than hydrochlorothiazide.
- Findings support the guideline recommendation for combination therapy in hypertension management.
Introduction:
Four different antihypertensive drug classes are equivalently recommended in the previous guidelines for first-line treatment of arterial hypertension (HTN). However, it is unclear, whether one of these drugs is more capable than the others to reach blood pressure (BP) control. We sought to compare response rates and BP control in these 4 classes.
Methods:
Patients with newly diagnosed mild to moderate HTN on 24-h BP measurements (ABPM) were randomized in a 1:1:1:1 fashion to either perindopril, olmesartan, amlodipine, or hydrochlorothiazide (HCT). ABPM was completed at baseline (BL) and after 4 weeks of half dose (treatment period 1 [TP1]). If BP control was not reached after TP1, drug dose was doubled and another ABPM completed after 4 weeks (treatment period 2 [TP2]). Patients were classified as controlled if 24-h mean BP was <130/80 mm Hg, awake BP <135/85 mm Hg, and night BP <120/70 mm Hg, and as optimal if 24-h mean BP was 115-124/65-74 mm Hg.
Results:
88 patients were randomized: 20 (23%) to perindopril, 23 (26%) to olmesartan, 24 (27%) to amlodipine, and 21 (24%) to HCT. Median 24-h mean BP reduction from BL to TP1 was -11/-6 mm Hg and from TP1 to TP2 -4/-2 mm Hg. The highest BP reduction was reached with olmesartan (-15/-10 mm Hg), particularly for diastolic values, the lowest with HCT (-8/-1 mm Hg). 27% of patients reached systo-diastolic BP control, with the best control rate with perindopril and olmesartan (40 and 39%), the lowest with HCT (5%), and 21%/18% reached an optimal treatment goal for systolic/diastolic 24-h mean values, respectively, after TP1. Three additional participants (4%) reached BP control after TP2.
Conclusion:
Initial antihypertensive monotherapy failed in most patients (73% uncontrolled, 21%/18% reached optimal treatment goal at TP1) even in low-risk patients, with efficacy varying by drug class (inhibitors of the renin-angiotensin-aldosterone system best, HCT least). These findings support guideline-recommended combination therapy.
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