FIXED HIGH-DOSE TRIPLE COMBINATION ANTIHYPERTENSIVE MEDICATION IN PATIENTS WITH UNCONTROLLED HYPERTENSION

Abstract

Objective: to evaluate efficacy and safety use of 3 antihypertensive medications including a calcium channel blocker, a blocker of the renin-angiotensin system and a thiazide diuretic with a maximal dose for 3 months in patients with long uncontrolled hypertension. Design and method: We studied 117 patients with uncontrolled hypertension which was confirmed by the office and 24-h ambulatory blood pressure monitoring (ABPM). All patients used 3.6 ± 0.1 antihypertensive drugs in free combinations. The adherence was moderate or low in 80 % of patients by the Morisky-Green test. After baseline examination patients have started treatment with the 3-component fixed-dose combination (FDC) of valsartan 320 mg/ hydrochlorothiazide 25 mg/ amlodipine 10 mg daily. The mean baseline systolic/diastolic BP was 170.2 ± 1.6/98.8 ± 1.2 mmHg and 24-h ambulatory BP was 160.3 ± 1.3/93.3 ± 1.1 mmHg. Results: After 3 months of treatment with triple combination pill, BP target was achieved in 57.3 % of patients according to the results of office and ABPM. In controlled hypertension (HTN) patients there was attenuated prevalence of non-dipping at the final evaluation (37 % vs 19 %, P < 0.01). The other 50 patients were classified as patients with resistant hypertension (RH). Patients with RH had a longer duration of hypertension, higher plasma aldosterone and 24-h urinary metanephrines, higher 24–h urinary sodium and were included more subjects with obesity, diabetes mellitus, chronic kidney disease (CKD), coronary artery disease than HTN patients (all P < 0.05). During the study, there were no adverse events such as dizziness, presyncope, or syncope, and headache. At the end of treatment, in HTN patients without initial CKD, creatinine level increased by 12.8% (P = 0.003), and GFR decreased by 10.0% (P = 0.004). Conclusions: The use of the fixed high-dose triple combination of antihypertensive drugs normalizes office and 24-hour BP in 57 % patients and differentiates the patients with true RH among the patients with low adherence to treatment and ineffective previous multicomponent therapy. BP lowering in patients without CKD has shown an increase in creatinine level and possibly refers to hemodynamic changes rather than renal damage; it requires observation.