Document Detail


Initial monotherapy and combination therapy and hypertension control the first year.
MedLine Citation:
PMID:  22566499     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Initial antihypertensive therapy with single-pill combinations produced more rapid blood pressure control than initial monotherapy in clinical trials. Other studies reported better cardiovascular outcomes in patients achieving lower blood pressure during the first treatment year. We assessed the effectiveness of initial antihypertensive monotherapy, free combinations, and single-pill combinations in controlling untreated, uncontrolled hypertensives during their first treatment year. Electronic record data were obtained from 180 practice sites; 106 621 hypertensive patients seen from January 2004 to June 2009 had uncontrolled blood pressure, were untreated for ≥ 6 months before therapy, and had ≥ 1 one-year follow-up blood pressure data. Control was determined by the first follow-up visit with blood pressure <140/<90 mm Hg for patients without diabetes mellitus or chronic kidney disease and <130/<80 mm Hg for patients with either or both conditions. Multivariable hazards regression ratios (HRs) and 95% CIs for time to control were calculated, adjusting for age, sex, baseline blood pressure, body mass index, diabetes mellitus, chronic kidney disease, cardiovascular disease, initial therapy, final blood pressure medication number, and therapeutic inertia. Patients on initial single-pill combinations (N = 9194) were more likely to have stage 2 hypertension than those on free combinations (N = 18 328) or monotherapy (N = 79 099; all P<0.001). Initial therapy with single-pill combinations (HR, 1.53 [95% CI, 1.47-1.58]) provided better hypertension control in the first year than free combinations (HR, 1.34; [95% CI, 1.31-1.37]) or monotherapy (reference) with benefits in black and white patients. Greater use of single-pill combinations as initial therapy may improve hypertension control and cardiovascular outcomes in the first treatment year.
Authors:
Brent M Egan; Dipankar Bandyopadhyay; Stephanie R Shaftman; C Shaun Wagner; Yumin Zhao; Kristina S Yu-Isenberg
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2012-05-07
Journal Detail:
Title:  Hypertension     Volume:  59     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-05-17     Completed Date:  2012-07-25     Revised Date:  2013-06-25    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1124-31     Citation Subset:  IM    
Affiliation:
Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA. eganbm@musc.edu
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MeSH Terms
Descriptor/Qualifier:
African Americans / statistics & numerical data
Antihypertensive Agents / therapeutic use*
Blood Pressure / drug effects*
Drug Therapy / methods,  statistics & numerical data
Drug Therapy, Combination
European Continental Ancestry Group / statistics & numerical data
Female
Humans
Hypertension / drug therapy*,  ethnology,  physiopathology
Male
Middle Aged
Multivariate Analysis
Outcome Assessment (Health Care) / methods,  statistics & numerical data
Proportional Hazards Models
Retrospective Studies
Time Factors
Grant Support
ID/Acronym/Agency:
1UL1RR029882/RR/NCRR NIH HHS; DK067615/DK/NIDDK NIH HHS; HL091841/HL/NHLBI NIH HHS; HL105880/HL/NHLBI NIH HHS; P20 RR-017696/RR/NCRR NIH HHS; R34 HL105880/HL/NHLBI NIH HHS; UL1 RR029882/RR/NCRR NIH HHS; UL1 TR000062/TR/NCATS NIH HHS
Chemical
Reg. No./Substance:
0/Antihypertensive Agents
Comments/Corrections

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