The Effectiveness of Triple Fixed-Dose Combination Therapy in the Management of Uncontrolled Arterial Hypertension

Abstract

The aim of our study was to identify patients with uncontrolled hypertension (UCH) who were resistant to previous antihypertensive therapy (AHT) and to assess the clinical efficacy of the fixed-dose triple combination (FDTC) therapy during 6 months. Methods and Results: The study included 156 patients with UCH. The mean age of patients was 57.81±10.8 years; the average duration of AH was 8.87±5.34 years. According to the questionnaire data, all patients received dual or triple free-combination AHT, but did not reach the target blood pressure (BP) level. After the screening stage, all patients were discontinued from previous therapy and assigned to the FDTC therapy. Patients initially taking angiotensin-converting enzyme inhibitors (n=96/61.5%) were switched to single-pill triple combination (SPTC) of perindopril, indapamide and amlodipine (Per/Ind/Aml [5mg/1.25mg/5mg]). Patients initially taking angiotensin receptor blockers (n=60/38.5%) were switched to SPTC of telmisartan, hydrochlorothiazide and amlodipine (Tel/HCTZ/Aml [40mg/12.5mg/5mg]). The primary target level for SBP and DBP was <140mmHg and <90mmHg, respectively. With good tolerability of therapy, we aimed for the recommended target level of SBP/DBP (<130mmHg/<80 mmHg). All patients underwent the following examinations: assessment of traditional risk factors, physical examination, clinical and biochemical laboratory methods, 12-lead ECG, echocardiography, pulse contour analysis, and 24-hour ambulatory blood pressure monitoring. The results of our study showed that the FDTC therapy at the indicated initial doses in patients with UCT made it possible to achieve the primary target BP level in 73.7% of patients after 3 months of treatment. A further increase in SPTC doses made it possible to increase the number of patients (after 6 months of treatment)who achieved the primary goal to 92.3%, and the recommended goal in 82.4% of patients. After 6 months of treatment, against the background of selected doses of SPTC, 7.7% of patients were diagnosed with treatment-resistant hypertension. Conclusion: Markers of UCH are high SBP, DBP, and increased pulse wave velocity, which requires the maximum doses of a full-dose SPTC of antihypertensive drugs (Per/Ind/Aml or Tel/HCTZ/Aml), without wasting time on titration of drug doses.