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Fixed-dose Combination Therapy in the Treatment of Hypertension: Ready for Prime Time

Jan N. Basile, MD
Volume: 100 Issue: 4 April, 2007

Abstract:

Hypertension, defined as a systolic blood pressure (BP) ≥140 mm Hg or a diastolic BP ≥90 mm Hg, remains the most common reason that physicians see patients on a continuous outpatient basis and prescribe chronic prescription medication. Patients with hypertension are at a two- to fourfold increased risk for cardiovascular (CV) disease, stroke, peripheral arterial disease and heart failure. Evidence from clinical trials has shown that effective, long-term control of BP to <140/90 mm Hg can reduce the incidence of stroke by nearly 40%, myocardial infarction (MI) by 25% and heart failure by more than 50%.1 With about 65 million Americans having hypertension, only 54% of those being treated with pharmacologic therapy have their BP controlled to the currently recommended goal of <140/<90 mm Hg.2 In clinical outcome trials, however, BP control rates are better than those achieved in clinical practice, with control rates approaching 70%. Reasons for the improved control rates in clinical trials include keeping to a fixed appointment schedule, an available formulary at no cost to the participant, a treatment algorithm with set titration instructions telling the clinician when to increase the dose or add another antihypertensive medication, and the “volunteer effect”—patients helping us to help them with the future hopes of helping others based on the results of the trial.

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References:

1. Neal B, MacMahon S, Chapman N, Blood Pressure Lowering Treatment Trialists’ Collaboration. Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Blood Pressure Lowering Treatment Trialists’ Collaboration. Lancet 2000;356:1955–1964.
 
2. Fields LE, Burt VL, Cutler JA, et al. The burden of adult hypertension in the United States 1999 to 2000: a rising tide. Hypertension 2004;44:398–404.
 
3. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA 2002;288:2981–2997.
 
4. Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003;42:1206–1252.
 
5. Nash DT. Rationale for combination therapy in hypertension management: focus on angiotensin receptor blockers and thiazide diuretics. South Med J 2007;100:386–392.
 
6. Berlowitz DR, Ash AS, Hickey EC, et al. Inadequate management of blood pressure in a hypertensive population. N Engl J Med 1998;339:1957–1963.
 
7. Okonofua EC, Simpson KN, Jesri A, et al. Therapeutic inertia is an impediment to achieving the Healthy People 2010 blood pressure control goals. Hypertension 2006;47:345–351.

CME:

Portions of this issue may be available for CME credit. Please email education@sma.org for a complete listing of current Southern Medical Journal activities, as well as other SMA educational offerings.

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