Elsevier

American Heart Journal

Volume 162, Issue 2, August 2011, Pages 340-346
American Heart Journal

Clinical Investigation
Hypertension
Combination therapy as initial treatment for newly diagnosed hypertension

https://doi.org/10.1016/j.ahj.2011.05.010Get rights and content

Background

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends that clinicians consider the use of multidrug therapy to increase likelihood of achieving blood pressure goal. Little is known about recent patterns of combination antihypertensive therapy use in patients being initiated on hypertension treatment.

Methods

We investigated combination antihypertensive therapy use in newly diagnosed hypertensive patients from the Cardiovascular Research Network Hypertension Registry. Multivariable logistic regression was used to assess the relationship between combination antihypertensive therapy and 12-month blood pressure control.

Results

Between 2002 and 2007, a total of 161,585 patients met criteria for incident hypertension and were initiated on treatment. During the study period, an increasing proportion of patients were treated initially with combination rather than with single-agent therapy (20.7% in 2002 compared with 35.8% in 2007, P < .001). This increase in combination therapy use was more pronounced in patients with stage 2 hypertension, whose combination therapy use increased from 21.6% in 2002 to 44.5% in 2007. Nearly 90% of initial combination therapy was accounted for by 2 combinations, a thiazide and a potassium-sparing diuretic (47.6%) and a thiazide and an angiotensin-converting enzyme inhibitor (41.4%). After controlling for relevant clinical factors, including subsequent intensification of treatment and medication adherence, combination therapy was associated with increased odds of blood pressure control at 12 months (odds ratio compared with single-drug initial therapy 1.20; 95% CI 1.15-1.24, P < .001).

Conclusions

Initial treatment of hypertension with combination therapy is increasingly common and is associated with better long-term blood pressure control.

Section snippets

Definition of the hypertensive cohort

This study was conducted within the CVRN, a consortium of research organizations affiliated with the Health Maintenance Organization Research Network and sponsored by the National Heart, Lung, and Blood Institute. The CVRN Hypertension Registry includes all adult patients with hypertension at 3 large integrated health care delivery systems, HealthPartners of Minnesota, Kaiser Permanente Colorado, and Kaiser Permanente Northern California. The algorithm for entry into the cohort has been

Baseline characteristics of patients with incident hypertension

Among 161,585 patients with incident hypertension being initiated on therapy during the study period, there was a decline in the proportion of individuals entering the cohort with stage 2 hypertension (defined as initial SBP ≥160 mm Hg or DBP ≥100 mm Hg), from 58.7% in 2002 to 40.0% in 2007 (P < .001) (Figure 1). There was a corresponding decrease in SBP during the same period from a mean SBP of 158.1 mm Hg for those entering the cohort in 2002 to a mean of 152.3 mm Hg for those entering in

Discussion

The objectives of this study were to assess trends in the use of combination versus single-agent therapy as initial treatment for patients with incident hypertension and to evaluate the use of combination therapy and BP control. We found that initial therapy with 2 drugs for new-onset hypertension was associated with better BP control at 12 months compared with single-agent therapy even after adjusting for, among other factors, subsequent therapy intensification and medication adherence. The

Disclosures

Conflicts of Interest/Disclosure(s): P. M. H. serves as a consultant for Wellpoint, Inc.

References (14)

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Sources of funding: This study was funded by grant U19HL091179 from the National Heart, Lung, and Blood Institute as part of the Cardiovascular Research Network. Dr Ho is supported by a Veterans Affairs Research & Development Career Development Award (05-026-2). Dr Byrd was supported by a Department of Veterans Affairs Cardiology Research Fellowship.

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