NOVEL EXPERIENCE WITH COMBINED FIX-DOSE THERAPY FOR HYPERTENSION

  • Ted Trjacheski Clinical Hospital Tetovo - Macedonia

Abstract

In spite of the general improvement in treatment strategy and novel medications for hypertension, still there are many patients with unsatisfactory results. In this study we retrospectively analyzed the local registry for 280 hypertension patients, referred during 18 months. Aims: To access the efficacy and safety of combined fix-dose therapy approach. Patients were grouped according to the number of antihypertensive medications and mono or fix-combined therapy and followed for 1 month in respect of obtaining target blood pressure control. Patients were informed about taking proper measurements and in respect of drug side effects. Clinical data on previous medical history findings were obtained. Statistical analysis was performed using SPSS 23.0 software package. Parameters were expressed as mean ± SD and percentages for nominal values. Comparative analysis was performed using X2 test.Statistical significance was set at p<0.05.Results: The mean age of study participants was over 60 years and there were 47 percentage of men. Obesity was present in almost 20% and quarter were active smokers.Most of the patients were in stage 1 (40%), 37% were in stage 3. The most of the patients and nearly half of all, were treated with fix-dose combined therapy, exporting 48%. Dual therapy with two separate pills was applied in 34% and with only one medicament were treated 16% of patients. The triple therapy was given to only 2% of patients. Patients treated with fix-dose combined therapy were compared with all other patients treated with mono, dual or triple therapy. The two groups of patients did not differ in respect of presence of Diabetes (p=0.676). Those treated with fix combinations were significantly younger (p=0.045), less male (0.001), more burdened with obesity (p=0.028) and more frequently smokers (p= 0.0001). After one month in 95% of patients the blood pressure reached the recommended targets. In 5% the follow up was not completed. Considering drug side effects, three patients treated with mono ACE therapy complained of dry cough and the treatment was replaced with a propriate dose medicament. Conclusion: Combined fox-dose therapy is shown to be of high efficacy and safety in patients with poor control of hypertension, especially in patients with low therapy adherence and at higher cardiovascular risk.

References

1. Chow C, Teo K, Rangarajan S, et al. PURE (Prospective Urban Rural Epidemiology) Study Investigators.
Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high,
middle, and low-income countries. JAMA. 2013; 310:959–68.
2. Mills T, Kelly N, Reed E, et al. Disparities of hypertension prevalence and control: a systematic analysis of
population-based studies from 90 countries.
3. Benetos A, Thomas F, Bean KE, Guize L. Why cardiovascular mortality is higher in treated hypertensives
versus subjects of the same age, in the general population. J Hypertens. 2003; 21:1635–40.
4. Ezzati M, Riboli E. Behavioral and dietary risk factors for noncommunicable diseases. N Engl J Med. 2013;
369:954–64
5. Joint National Committee. Report on detection, evaluation and treatment of high blood pressure. JAMA.
1977; 237:255–61
6. WHO Expert Committee. Arterial Hypertension. Geneva: World Health Organization. Tech Rep Series1978;
628:7–58
7. Law MR, Wald NJ, Morris JK, Jordan RE. Value of low dose combination treatment with blood pressure
lowering drugs: analysis of 354 randomized trials. BMJ. 2003; 326:1427.
8. Tedla YG, Bautista LE. Drug side effect symptoms and adherence to antihypertensive medication. Am J
Hypertens. 2016; 29:772–9.
9. Hirakawa Y, Arima H, Webster R, Zoungas S, Li Q, Harrap S, Lisheng L, Hamet P, Mancia G, Poulter N, Neal B,
Williams B, Rogers A, Woodward M, Chalmers J. Risks associated with permanent discontinuation of blood
pressure-lowering medications in patients with type 2 diabetes. J Hypertens. 2016; 34:781–7
10. Chobanian V, Bakris L, Black R, et al. National Heart, Lung, and Blood Institute Joint National Committee on
Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure
Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on
Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA.
2003;289:2560–72
11. Weber A, Schiffrin L, White B, et al. Clinical practice guidelines for the management of hypertension in the
community a statement by the American Society of Hypertension and the International Society of
Hypertension. J Hypertens. 2014;32:3–15.
12. Corrao G, Zambon A, Parodi A, et al. Discontinuation of and changes in drug therapy for hypertension
among newly-treated patients: a population-based study in Italy. J Hypertens. 2008;26:819–824.
13. Chobanian V, Bakris L, Black R, et al. National Heart, Lung, and Blood Institute Joint National Committee on
Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure
Education Program Coordinating Committee. The Seventh Report of the Joint National Committee on
Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA.
2003;289:2560–72
14. Mancia G, Fagard R, Narkiewicz K, et al; Task Force Members. 2013 ESH/ESC Guidelines for the management
of arterial hypertension: the task force for the management of arterial hypertension of the European Society
of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31:1281–357.
15. Mancia G, De Backer G, Dominiczak A, et al; Management of Arterial Hypertension of the European Society
of Hypertension; European Society of Cardiology. 2007 guidelines for the management of arterial
hypertension: the task force for the management of arterial hypertension of the European Society of
Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007;25:1105–87
16. Whelton K, Carey M, Aronow S, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA
guideline for the prevention, detection, evaluation, and management of high blood pres- sure in adults: a
report of the American College of Cardiology/American Heart Association task force on clinical practice
guidelines. Hypertension. 2018;71:13–115.
17. Williams B, Mancia G, Spiering W, et al; ESC Scientific Document Group. 2018 ESC/ESH guidelines for the
management of arterial hypertension. Eur Heart J. 2018;39:3021–104
18. Smoking Rates By Country Population. (2019-10-24). Retrieved 2019-10-28, from
http://worldpopulationreview.com/countries/smoking-rates-by-country/
19. Lonn EM, Bosch J, López-Jaramillo P, et al; HOPE-3 Investigators. Blood- pressure lowering in intermediate-
risk persons without cardiovascular disease. N Engl J Med. 2016;374:2009–20
20. Schroeder K, Fahey T, Hay D, Montgomery A, Peters J. Relationship between medication adherence and
blood pressure in primary care: prospective study. J Hum Hypertens. 2006;20:625–7.
21. Corrao G, Rea F, Ghirardi A, Soranna D, Merlino L, Mancia G. Adherence with antihypertensive drug therapy
and the risk of heart failure in clinical practice. Hypertension. 2015;66:742–9.
22. Egan M, Bandyopadhyay D, Shaftman R, Wagner S, Zhao Y, Yu- Isenberg S. Initial monotherapy and
combination therapy and hyper- tension control the first year. Hypertension. 2012;59:1124–31.
23. Mancia G, Zambon A, Soranna D, Merlino L, Corrao G. Factors involved in the discontinuation of
antihypertensive drug therapy: an analysis from real life data. J Hypertens. 2014;32:1708–15
24. Corrao G, Nicotra F, Parodi A et al. Cardiovascular protection by initial and subsequent combination of
antihypertensive drugs in daily life practice. Hypertension. 2011;58:566–72
Published
2019-12-27
How to Cite
TRJACHESKI, Ted. NOVEL EXPERIENCE WITH COMBINED FIX-DOSE THERAPY FOR HYPERTENSION. Journal of Morphological Sciences, [S.l.], v. 2, n. 2, p. 3-9, dec. 2019. ISSN 2545-4706. Available at: <http://jms.mk/jms/article/view/74>. Date accessed: 19 jan. 2020.
Section
Articles