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Dual combination of BP-lowering drugs trumps monotherapy as initial treatment for hypertension

11 Aug 2019

Treatment with low-to-standard dose dual combination therapy of blood pressure (BP)-lowering drugs is more effective than standard-dose monotherapy and does not increase withdrawals due to adverse events, a recent study has shown.

The investigators searched Medline, Embase and Central databases until August 2017 for double-blind randomized trials of dual combination therapy vs monotherapy in adults with hypertension who were either treatment naïve or untreated for at least 4 weeks. They classified regimens with reference to usual daily standard dose: for example, <1 + <1 for a combination of two drugs both a <1 standard-dose.

Random-effects models were used for the meta-analysis of 33 trials, which included a total of 13,095 participants with mean baseline BP of 155/100 mm Hg.

Dual combination of <1 + <1, 1 + <1, and 1 + 1 (ie, low-to-standard dose) vs standard-dose monotherapy demonstrated a dose–response relationship in reducing systolic BP (mean differences, 2.8 [95 percent CI, 1.6–4.0], 4.6 [3.4–5.7] and 7.5 [5.4–9.5] mm Hg, respectively) and in improving BP control (risk ratio [RR], 1.11 [0.92–1.34], 1.25 [1.16–1.35] and 1.42 [1.27–1.58], respectively).

Low-to-standard dose dual combinations also led to few withdrawals due to adverse events, showing no significant difference relative to those of standard-dose monotherapy (2.9 percent vs 2.2 percent; RR, 1.28, 0.85–1.92).

“There were fewer data for higher dose dual combinations, which did not appear to produce substantial additional efficacy and could potentially be less tolerable,” the investigators noted.

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Most Read Articles
Roshini Claire Anthony, 6 days ago

Beta-blockers could reduce mortality risk in patients with heart failure with reduced ejection fraction (HFrEF) and moderate or moderately-severe renal dysfunction without causing harm, according to the BB-META-HF* trial presented at ESC 2019.

Prof. Vincent Wong, Prof. Ray Kim, Dr. Tan Poh Seng, 10 Sep 2019
Chronic hepatitis B (CHB) remains a major public health concern because of its worldwide distribution and potential adverse sequelae, including cirrhosis and hepatocellular carcinoma (HCC). At a recent symposium held during the GIHep Singapore 2019, Professor Vincent Wong from the Chinese University of Hong Kong and Professor Ray Kim from the Stanford University School of Medicine, Stanford, California, US, discussed antiviral treatments for CHB, with a focus on the novel agent tenofovir alafenamide (Vemlidy®). Dr Tan Poh Seng from the National University Hospital, Singapore, chaired the symposium.
11 Sep 2019
Blood pressure (BP) in children is influenced by early-life exposure to several chemicals, built environment and meteorological factors, suggests a study.
Pearl Toh, 18 hours ago
The use of SGLT-2* inhibitors was not associated with a higher risk of severe or nonsevere urinary tract infections (UTIs) in patients with type 2 diabetes (T2D) compared with DPP**-4 inhibitors or GLP-1*** receptor agonists, a population-based cohort study shows.