USE OF COMBINATION TREATMENT IN HYPERTENSION MANAGEMENT AND ITS ASSOCIATION WITH HYPERTENSION CONTROL

Abstract

Objective: Achievement of blood pressure (BP) targets in hypertension is crucial for cardiovascular prevention and, in most cases, requires combined pharmacological treatment. Current ESC/ESH Guidelines for hypertension management recommend initiating treatment with combination therapy in most hypertensives, except low-risk individuals with mildly elevated BP. Our aim was to assess how this recommendation is applied in practice and whether it is associated with differences in hypertension control. Design and method: In the setting of an ongoing cardiovascular prevention trial (CV-PREVITAL) we prospectively recruited 278 hypertensive patients with no history of cardiovascular disease, among individuals who responded to the advertisement campaign in outpatient facilities of Istituto Auxologico Italiano. Physical examination, standard routine blood tests, office blood pressure recording and standard 24h ABPM has been performed at baseline. We analyzed the office and ambulatory BP control in relationship to the number of antihypertensive drugs and cardiovascular risk assessed by SCORE for low risk countries. Results: Median age of our sample was 61 years, with balanced gender distribution. Ninety-nine (36%) participants were not receiving any pharmacological treatment, 106 (41%) were on monotherapy and 73 (23%) on combined treatment. Comparison of principal characteristics among the three groups is shown in Table 1. Among study participants 44 (16%) had low to moderate CV risk and 227 (84%) had high or very high estimated risk. The percentage of participants receiving combined treatment in these groups was 4.1% and 22.5%, respectively, and the percentage of patients with well controlled office/ambulatory BP was 50%/41% in low to moderate risk and 35%/65% in high to very high risk participants, respectively. Conclusions: In this sample of patients with known hypertension, a considerable proportion received substandard treatment (no treatment or monotherapy), even among those at high risk. This was associated with worse BP control in these individuals. Implementation of current hypertension guidelines in practice remains largely suboptimal.