PROSPECTS FOR INITIAL TRIPLE ANTIHYPERTENSIVE THERAPY

Abstract

The currently recommended initial dual antihypertensive therapy (AHT) results in poor blood pressure (BP) control, whereas most patients should undergo triple-combination therapy to achieve target levels. We have found only foreign publications concerning initial triple antihypertensive treatment.
 The aim of the study is to compare the traditional step by step strategy of drug administration and application of three antihypertensive drugs simultaneously.
 Materials and Methods. Trial subjects were divided into 2 groups: patients who received conventional dual therapy followed by a third drug agent (n=59) and patients who received initial triple AHT (n=57). The frequency of prescribed drugs and their dosage were comparable. The examination was carried at hospital according to the current standards of medical care for hypertensive adults. Values <140/90 mm Hg were taken as BP target level. Office blood pressure was tested 1 and 3 months after the therapy. 24-hour BP control was carried out 12 weeks after treatment.
 Results. The analysis of cardiovascular risks (CVRs) did not reveal significant intergroup differences (p>0.05). Both treatment regimens demonstrated fewer complaints and a comparable frequency of adverse reactions (p>0.05). Intergroup comparison conducted 1 month after treatment showed lower SBP and DBP levels (p<0.001) and a significant decrease in blood pressure in the 2nd group compared to baseline (p<0.001). The chance of achieving BP target level with the traditional scheme was 0.20, while with the initial triple AHT it was 2.35. The odds ratio was 11.53 (95 % CI 4.76; 27.96).
 Conclusion. Initial triple antihypertensive therapy has an advantage over the conventional one due to faster achievement of BP target levels. Given the comparable efficacy and frequency of adverse reactions, the strategy may be of interest for further study and implementation in practical medicine.