Published online before print December 18, 2006, doi: 10.1161/01.HYP.0000254479.66645.a3
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(Hypertension. 2007;49:272.)
© 2007 American Heart Association, Inc.
Original Articles |
Low-Dose Quadruple Antihypertensive Combination
More Efficacious Than Individual Agents-A Preliminary Report
From the Department of Pharmacology and Therapeutics (A.M., J.F.), Trinity College Dublin, Centre for Health Sciences, Dublin, Ireland; and the Hypertension Clinic (A.M., J.F.), St James’s Hospital, Dublin, Ireland.
Correspondence to John Feely, Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James’s Hospital, Dublin 8, Ireland. E-mail jfeely{at}tcd.ie
Increasingly combined antihypertensive agents are being used in practice to enhance control and improve compliance. To determine whether a capsule containing a quarter of the standard dose of 4 antihypertensive agents has greater efficacy than the standard dose of each individually, we prospectively randomized 108 untreated white hypertensive patients (55% male) aged 50±1 years (mean±SEM), with mean blood pressure 160±1/96±1 mm Hg. Patients received amlodipine (5 mg; n=22), atenolol (50 mg; n=20), bendroflumethiazide (2.5 mg; n=22), captopril (50 mg twice daily; n=22) or a capsule containing each of the 4 above at one-quarter dosage (n=22) in a parallel group design for 4 weeks. Blood pressure was measured using a semiautomated device (Omron 705), and the reduction in mean arterial pressure with the combined preparation was compared with that of the individual components. Statistical analysis used ANOVA and Tukey-Kramer honestly significant difference for multiple comparisons. The reduction in mean arterial pressure with the combination (19±2 mm Hg) was significantly greater than that with individual agents amlodipine (10±2 mm Hg; P<0.005), atenolol (10±2 mm Hg; P<0.005), bendroflumethiazide (6±1 mm Hg; P<0.005), and captopril (11±1 mm Hg; P<0.01). In addition, the percentage reduction in systolic (18±1 mm Hg; P<0.005) and diastolic (17±2 mm Hg; P=0.06) blood pressure was greater with the combination. More patients achieved a blood pressure of <140/90 mm Hg with the combination (60%) than any individual drug (15% to 45%; P<0.05). A low-dose combination of 4 agents representing 4 classes of standard antihypertensive agents was more efficacious than a standard single dose of each agent individually.
Key Words: antihypertensive drugs • hypertension • antihypertensive combinations • blood pressure
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