Tenter d’atteindre rapidement la cible tensionnelle chez les hypertendus nouvellement diagnostiqués est efficace et sans danger

Abstract

ObjectivesTo compare a so-called an “accelerated” antihypertensive strategy to a “standard” strategy, in terms of blood pressure control rates and adverse events. MethodsProspective open-label randomized controlled trial, which included consecutive hypertensive patients, newly diagnosed, 40 to 70 years old, with no prior antihypertensive treatment. Hypertension was diagnosed if office blood pressure was≥140/90mmHg, confirmed by an increase of Home or a daytime ambulatory blood pressure. The patients were randomly assigned according to 1:1 ratio to an “accelerated” strategy or to a “standard” strategy. The primary end-point was the rate of blood pressure control at 12weeks. The secondary end-point was the rate of adverse events (a safety end-point). ResultsWe recruited 268 patients (132 in the “accelerated” strategy group), with a mean age of 55 years and 62% of men. The mean office blood pressure at baseline was 168/95mmHg. The clinical characteristics were on average similar between the 2 treatment groups. At 12 weeks, the rates of blood pressure control were 63.6% in the “accelerated” strategy and 38.2% in the “standard” strategy (P<0.001). There was no significantly difference between the rates of adverse events in the 2 strategies (6.06% versus 5.14%; P=0.8). ConclusionThe “accelerated” antihypertensive strategy was more effective than a standard one, in terms of blood pressure control, without an increase in adverse events rate. This could translate into a future cardiovascular events reduction.