Combination therapy as initial treatment for newly diagnosed hypertension

Abstract

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.

Figure 1

Study participants’ baseline blood pressure upon entering the hypertension cohort. Between 2002 and 2007, there was an increase in the proportion of patients whose baseline blood pressure was in the stage 1 range (blue line). There was a corresponding decrease in the proportion with a baseline blood pressure in the stage 2 range (red line).

Figure 2

Study participants’ mean blood pressure upon entering the hypertension cohort. The error bars represent standard deviation. Between 2002 and 2007, the mean systolic blood pressure of patients with incident hypertension decreased. The mean diastolic blood pressure differed little in 2002 compared to 2007.

Figure 3

The use of two-drug combination antihypertensive therapy as initial treatment for incident hypertension increased significantly between 2002 and 2007. The increase was larger among patients with stage 2 hypertension at time of diagnosis.