Efficacy and safety of dual combination therapy of blood pressure-lowering drugs as initial treatment for hypertension
- 1 September 2019
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of Hypertension
- Vol. 37 (9), 1768-1774
- https://doi.org/10.1097/hjh.0000000000002096
Abstract
To assess the efficacy and tolerability of dual combination of blood pressure (BP)-lowering drugs as initial treatment for hypertension. MEDLINE, Embase, CENTRAL were searched until August 2017 for randomized, double-blind trials of dual combination therapy vs. monotherapy in adults with hypertension who were either treatment naïve or untreated for at least 4 weeks. Regimens were classified with reference to usual daily ‘standard-dose’; for example, <1 + <1 for a combination of two drugs both at less than one standard-dose. Random-effects models were used for meta-analysis. Thirty-three trials (13 095 participants) with mean baseline mean BP 155/100 mmHg were included. Compared with standard-dose monotherapy, dual combinations of <1 + <1, 1 + <1 and 1 + 1 (i.e. low-to-standard dose), showed a dose–response relationship in reducing SBP [mean differences (95% confidence interval) of 2.8 (1.6–4.0), 4.6 (3.4–5.7) and 7.5 (5.4–9.5) mmHg, respectively], and in improving BP control [risk ratio (RR) (95% confidence interval) 1.11 (0.92–1.34), 1.25 (1.16–1.35) and 1.42 (1.27–1.58), respectively]. Withdrawals due to adverse events were uncommon with low-to-standard dose dual combinations, with no significant difference compared with standard-dose monotherapy [2.9 vs. 2.2%; RR 1.28 (0.85 to 1.92)]. There were fewer data for higher dose dual combinations, which did not appear to produce substantial additional efficacy and could potentially be less tolerable. Compared with standard-dose monotherapy, initiating treatment with low-to-standard dose dual combination therapy is more efficacious without increasing withdrawals due to adverse events. CRD42016032822.This publication has 29 references indexed in Scilit:
- Initial Monotherapy and Combination Therapy and Hypertension Control the First YearHypertension, 2012
- The Cochrane Collaboration's tool for assessing risk of bias in randomised trialsBMJ, 2011
- Reduced discontinuation of antihypertensive treatment by two-drug combination as first step. Evidence from daily life practiceJournal of Hypertension, 2010
- A narrative review of clinical inertia: focus on hypertensionJournal of the American Society of Hypertension, 2009
- Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studiesBMJ, 2009
- A Simplified Approach to the Treatment of Uncomplicated HypertensionHypertension, 2009
- Combination Therapy Versus Monotherapy in Reducing Blood Pressure: Meta-analysis on 11,000 Participants from 42 TrialsThe American Journal of Medicine, 2009
- Low-Dose Quadruple Antihypertensive CombinationHypertension, 2007
- Therapeutic Inertia Is an Impediment to Achieving the Healthy People 2010 Blood Pressure Control GoalsHypertension, 2006
- Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trialsBMJ, 2003