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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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