Published online before print February 23, 2009, doi: 10.1161/HYPERTENSIONAHA.109.128678
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(Hypertension. 2009;53:598.)
© 2009 American Heart Association, Inc.
Editorial Commentaries |
Fixed-Dose Combinations and Hypertension Control in Community-Based Practices
Application of the "Keep-It-Simple" Principle
From the Departments of Medicine and Pharmacology, Medical University of South Carolina, Charleston.
Correspondence to Brent M. Egan, Medical University of South Carolina, 135 Rutledge Ave, RT1230, Charleston, SC 29425. E-mail eganbm@musc.edu
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
The article by Feldman et al1 in the present issue of Hypertension documents that solo practitioners in the community can control blood pressure in more than half (
53%) of their uncomplicated, uncontrolled hypertensive patients by following the well-established, guideline-recommended, stepped-care algorithm. The solo practitioners achieved even better results, controlling 65% of these uncomplicated hypertensives, using fixed-dose combination-based therapy and a simplified management algorithm.
This study adds to the literature on fixed-dose combinations by demonstrating that the superior efficacy2 documented in controlled clinical trials translates into improved blood pressure control in community-based practices. It also demonstrates that primary care providers using the fixed-dose combination simplified algorithm are more satisfied with the care provided to their hypertensive patients, perceive it to be more effective, and are more likely to recommend the approach to a colleague than clinicians using the current guidelines. They also viewed this approach to be at least as sustainable as current guidelines. The fact that patients in clinics assigned to the fixed-dose combination arm received more classes of antihypertensive medications but fewer dose equivalents than patients in clinics assigned to the then-current guideline is consonant with the assignment and effectiveness of comparatively low-dose fixed combinations used. As the authors concluded, the results are consistent with the known additive blood pressure–lowering effects of the fixed-dose combinations selected and the evidence suggesting that patient adherence is also better.3
Recent reviews of barriers to implementing evidence-based guidelines in clinical practice consistently identify complexity of the intervention, as well as time and
Related Article:
Hypertension 2009 53: 646-653.