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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
Rachel Soon, 16 Aug 2019

On 8 August, the first town hall held by the Ministry of Health (MOH) with members of the pharmacy profession took place in Putrajaya. Over 500 pharmacists from across the country and from different areas of practice—community and hospital, public and private, academy and industry—converged to fill the auditorium for the chance to engage in direct dialogue with MOH.

3 days ago
Cardiac biomarkers are useful for identifying community-acquired pneumonia (CAP) patients with an elevated risk of early and long-term cardiovascular (CV) events, according to a study.
Yesterday
Tofogliflozin is safe and effective for elderly patients with type 2 diabetes mellitus (T2DM), regardless of insulin and oral antidiabetic drugs, reports a new Japan study.
6 days ago
Pulmonary function has potential predictive value for future increases in arterial stiffness and its progression, as reported in a recent study.