Initiation of hypertension treatment with a fixed-dose combination or its monocomponents -- does it really matter?
Despite efforts to diagnose and treat hypertension effectively, the goal of lowering blood pressure (BP) levels is rarely achieved, as treatment is often initiated with a single antihypertensive agent. The aim of this study was to assess the safety and efficacy of a first-line fixed-dose combination treatment compared with treatment with its monocomponents over a period of 4 weeks. Patients (n = 149) with essential hypertension were randomised to receive 2.5 mg of either ramipril or felodipine ER or the fixed-dose combination of ramipril 2.5 mg/felodipine ER 2.5 mg over a 4-week treatment period. BP and heart rate were measured by conventional methodology and 24-hour ambulatory blood pressure measurements. Treatment with the fixed-dose combination was significantly more effective in reducing systolic and diastolic BP (-15.8/-9.2 mmHg) compared with its monocomponents, ramipril (-7.6/-3.8 mmHg) and felodipine ER (-8.0/-5.0 mmHg). No significant difference could be observed in the occurrence of a greater fall in systolic and diastolic BP 6 h after the first dose of the three study medications. The adverse effects reported were mild, and less number of patients in the fixed-dose combination complained of adverse events. It can be concluded that initiating antihypertensive treatment with a low fixed-dose combination of ramipril/felodipine ER is more effective and safe when compared with treatment with its monocomponents.
University Hospital Charité Campus Charité Mitte Outpatient Department, Berlin, Germany. juergen.scholze@charite.de
J
J
Scholze
M
M
Bida
A
A
Hansen
D
D
Juncken
B
B
Rangoonwala
A
A
Ritz
J
J
Schnitker
Y
Y
Dörffel
D000959:Antihypertensive Agents / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D015736:Felodipine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D017257:Ramipril / Q000008:administration & dosage*; D016896:Treatment Outcome
D000959:Antihypertensive Agents; D017257:Ramipril; D015736:Felodipine