Abdul Salam1, Raju Kanukula1, Emily Atkins2, Xia Wang2, Shariful Islam2,3,4, Sandeep P Kishore5, Marc G Jaffe6,7, Anushka Patel2, Anthony Rodgers2. 1. The George Institute for Global Health, University of New South Wales, Hyderabad, India. 2. The George Institute for Global Health, University of New South Wales, Sydney, New South Wales. 3. Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Victoria. 4. Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia. 5. Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai Health System and Young Professionals Chronic Disease Network. 6. Resolve To Save Lives, New York, New York. 7. Kaiser Permanente, South San Francisco Medical Center, South San Francisco, California, USA.
Abstract
OBJECTIVE: To assess the efficacy and tolerability of dual combination of blood pressure (BP)-lowering drugs as initial treatment for hypertension. METHODS: MEDLINE, Embase, CENTRAL were searched until August 2017 for randomized, double-blind trials of dual combination therapy vs. monotherapy in adults with hypertension who were either treatment naïve or untreated for at least 4 weeks. Regimens were classified with reference to usual daily 'standard-dose'; for example, <1 + <1 for a combination of two drugs both at less than one standard-dose. Random-effects models were used for meta-analysis. RESULTS: Thirty-three trials (13 095 participants) with mean baseline mean BP 155/100 mmHg were included. Compared with standard-dose monotherapy, dual combinations of <1 + <1, 1 + <1 and 1 + 1 (i.e. low-to-standard dose), showed a dose-response relationship in reducing SBP [mean differences (95% confidence interval) of 2.8 (1.6-4.0), 4.6 (3.4-5.7) and 7.5 (5.4-9.5) mmHg, respectively], and in improving BP control [risk ratio (RR) (95% confidence interval) 1.11 (0.92-1.34), 1.25 (1.16-1.35) and 1.42 (1.27-1.58), respectively]. Withdrawals due to adverse events were uncommon with low-to-standard dose dual combinations, with no significant difference compared with standard-dose monotherapy [2.9 vs. 2.2%; RR 1.28 (0.85 to 1.92)]. There were fewer data for higher dose dual combinations, which did not appear to produce substantial additional efficacy and could potentially be less tolerable. CONCLUSION: Compared with standard-dose monotherapy, initiating treatment with low-to-standard dose dual combination therapy is more efficacious without increasing withdrawals due to adverse events. PROSPERO REGISTRATION: CRD42016032822.
OBJECTIVE: To assess the efficacy and tolerability of dual combination of blood pressure (BP)-lowering drugs as initial treatment for hypertension. METHODS: MEDLINE, Embase, CENTRAL were searched until August 2017 for randomized, double-blind trials of dual combination therapy vs. monotherapy in adults with hypertension who were either treatment naïve or untreated for at least 4 weeks. Regimens were classified with reference to usual daily 'standard-dose'; for example, <1 + <1 for a combination of two drugs both at less than one standard-dose. Random-effects models were used for meta-analysis. RESULTS: Thirty-three trials (13 095 participants) with mean baseline mean BP 155/100 mmHg were included. Compared with standard-dose monotherapy, dual combinations of <1 + <1, 1 + <1 and 1 + 1 (i.e. low-to-standard dose), showed a dose-response relationship in reducing SBP [mean differences (95% confidence interval) of 2.8 (1.6-4.0), 4.6 (3.4-5.7) and 7.5 (5.4-9.5) mmHg, respectively], and in improving BP control [risk ratio (RR) (95% confidence interval) 1.11 (0.92-1.34), 1.25 (1.16-1.35) and 1.42 (1.27-1.58), respectively]. Withdrawals due to adverse events were uncommon with low-to-standard dose dual combinations, with no significant difference compared with standard-dose monotherapy [2.9 vs. 2.2%; RR 1.28 (0.85 to 1.92)]. There were fewer data for higher dose dual combinations, which did not appear to produce substantial additional efficacy and could potentially be less tolerable. CONCLUSION: Compared with standard-dose monotherapy, initiating treatment with low-to-standard dose dual combination therapy is more efficacious without increasing withdrawals due to adverse events. PROSPERO REGISTRATION: CRD42016032822.
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Authors: Abdul Salam; Mark D Huffman; Raju Kanukula; Esam Hari Prasad; Abhishek Sharma; David J Heller; Rajesh Vedanthan; Anubha Agarwal; Anthony Rodgers; Marc G Jaffe; Thomas R Frieden; Sandeep P Kishore Journal: J Clin Hypertens (Greenwich) Date: 2020-08-20 Impact factor: 3.738