Time to achieve target blood pressure when changing initial antihypertensive therapy strategy

BACKGROUND. A standardized approach to the use of a dual drug combination in the treatment of arterial hypertension (AH) as a first step, with subsequent possible transition to a three-component combination, shows that approximately 50 % of patients require a triple combination. The use of this strategy leads to an increase in the time to achieve blood pressure (BP) control, and a possible decrease in patient adherence to the prescribed treatment.

OBJECTIVE. To evaluate the effectiveness of blood pressure control using a strategy of triple antihypertensive therapy as a restart antihypertensive therapy.

MATERIALS AND METHODS. The study included 165 patients with grade 2-3 hypertension and high or very high cardiovascular risk, aged 65 to 75 years, who did not regularly use antihypertensive drugs. Group A consisted of 96 patients with hypertension who were prescribed a dual antihypertensive combination as first-step therapy, including drugs from four first-line classes (angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin II receptor blockers (ARBs), calcium antagonists (CCBs), diuretics), with subsequent dose titration and possible addition of a third drug if the target BP level was not achieved. Group B included 69 patients with similar hypertension parameters who had previously taken dual antihypertensive therapy and noted its ineffectiveness (provided that no drugs were taken regularly during the last month). Office blood pressure monitoring was performed every 2-4 weeks; the dynamics of daily blood pressure parameters were assessed after 2 and 3 months.

RESULTS. Of the 96 patients in Group A, the target BP level with two-component therapy was achieved in 29 patients (30.2%). Effective BP control during the 2nd step of therapy with the addition of the third drug was achieved in another 59 patients in Group A (61.4%). In Group B, a faster achievement of the target BP level was observed. Already after 1 month of therapy in the restart three-component therapy group, the achievement of the target BP was observed in 40 patients (70.2%), which was accompanied by more significant dynamics of most daily BP parameters, whereas in Group A after 1 month of therapy, only 10 (16.9%) patients achieved the target BP, the rest were at the stage of dose and treatment strategy adjustment.

CONCLUSION. The use of a restart triple drug combination in patients indicating lack of blood pressure control when using two antihypertensive drugs in the past demonstrated a rapid rate of achieving target blood pressure levels and achieving early positive dynamics of daily blood pressure parameters. In patients with predictors of ineffective dual antihypertensive therapy, it is possible to shorten the first step with an early transition to a triple antihypertensive combination in order to achieve effective blood pressure control in the shortest possible time.