Amlodipine/Atorvastatin single-pill therapy for blood pressure and lipid goals in African Americans: influence of the metabolic syndrome and type 2 diabetes mellitus

Abstract

African Americans with diabetes +/- the metabolic syndrome are at high risk for cardiovascular disease. This subanalysis of the Clinical Utility of Caduet in Simultaneously Achieving Blood Pressure and Lipid End Points (CAPABLE) trial studied attainment of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) and the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) goals by 8 flexibly titrated doses (5/10-10/80 mg) of amlodipine/atorvastatin single pill in 494 African Americans with hypertension and dyslipidemia, according to the presence of diabetes +/- the metabolic syndrome. In 169 diabetic patients, the metabolic syndrome was associated with poorer BP goal attainment (38.5% vs 48.5% in diabetic patients without the metabolic syndrome). Among diabetic patients (+/- the metabolic syndrome) 61% to 62% reached LDL-C goal. More than 60% of patients with diabetes uncontrolled for LDL-C were maintained on suboptimal atorvastatin therapy (mean final dose: 29.9 mg vs maximum of 80 mg). Reluctance to intensify therapy to attain accepted targets in high-risk individuals suggests a degree of clinical inertia not explained by objective evidence of dose-dependent intolerance.

Figure 1

Blood pressure (BP) and low‐density lipoprotein cholesterol (LDL‐C) goal attainment by diabetes mellitus (DM) and/or the metabolic syndrome (MS) status in patients in risk group 3. JNC 7 indicates the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; NCEP ATP III, the National Cholesterol Education Program Adult Treatment Panel III.

Figure 2

Mean final dose of amlodipine/atorvastatin single‐pill therapy in patients in risk group 3 according to the metabolic syndrome (MS) and diabetes mellitus (DM) status.

Figure 3

Titration patterns for patients with diabetes mellitus (DM) in the presence and absence of the metabolic syndrome (MS) and (A) not at goal for blood pressure (BP), and (B) not at goal for low‐density lipoprotein cholesterol (LDL‐C). (a) Patients were included in this analysis if they were not at goal for BP as assessed by BP readings taken by the physician at each titration visit and if information on study drug dose and titration pattern were available for that visit. (b) Patients were included in this analysis if they were not at goal for LDL‐C based on the last available measurement of LDL‐C, and if information on study drug dose and titration pattern was available for that titration visit.