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