Improving adherence with amlodipine/atorvastatin therapy: IMPACT study

Abstract

Hypertension is prevalent in the United States and remains uncontrolled. The primary objective of the study was to determine the effect of once-daily dosing of a combination therapy for blood pressure (BP) and dyslipidemia using home BP monitoring on reaching clinical BP and the effect of daily dosing of combination therapy on reaching lipid goals. The study was conducted in middle-aged, indigent, African Americans who had high-risk, resistant hypertension and dyslipidemia. Patients were randomly assigned to either the home and clinic BP group or usual care group and were followed for 6 months. The average BPs for each group were compared and used to titrate the study drug appropriately. Both groups achieved significant declines in BP, total cholesterol, and low-density lipoprotein (LDL) (P<.0001). These findings demonstrate that BP control could be achieved at a rate of 43.5% compared with the 2004 national control rate of 35%. The LDL control rate was also improved. Cardiovascular risk reduction has been proven to be achieved through managing lipids and BP. This trial demonstrates that these goals can be achieved similar to other groups in indigent African Americans with high-risk hypertension and dyslipidemia.

Figure 1

Study design flowchart of patient visits and screening. *Six patients who returned for a final visit did not complete an ambulatory blood pressure measurement and they were equally distributed between the study groups.

Figure 2

Baseline blood pressure measurements for usual care (n=30) and home and clinic care (n=32) groups. SBP indicates systolic blood pressure; DBP, diastolic blood pressure.

Figure 4

Ambulatory blood pressure monitoring showed significant declines in blood pressure for both treatment groups from baseline to final. There is a trend that diastolic blood pressure (DBP) declined greater in the home and clinic care group (P=.55) (n=42). *P<.01, **P<.0001.

Figure 3

A statistically significant decline in clinic blood pressure for the entire study population from baseline to final with no group differences between systolic blood pressure (SBP) or diastolic blood pressure (DBP) decline from baseline to final (n=42). *P<.01, **P<.0001.