title: Time to achieve blood pressure goal with a combination versus a conventional monotherapy approach in hypertensive patients with metabolic syndrome.
abstract: The time to achieve a blood pressure (BP) goal < or =130/85 mmHg with a combination versus a conventional monotherapy approach was evaluated in 308 hypertensive patients with metabolic syndrome. They were randomized to valsartan (V) 8 mg/amlodipine (A) 5 mg combination or to V 160 mg monotherapy for 12 weeks and every 2 weeks, there was a titration in nonresponder patients: in the combination group V/A was progressively increased to V 160/A 5 mg; V160/A 7.5 mg; V160/A 10 mg; V 240/A 10 mg, and V 320/A 10 mg. In the monotherapy group, the regimen was progressively modified as following: V 240 mg; V 320 mg; V 320/A 5 mg; V 320/A 7.5 mg, and V 320/A 10 mg. The mean time to achieve the BP goal was shorter in patients randomized to combination therapy compared to those randomized to conventional monotherapy (4.7 +/- 2.7 weeks vs. 7.1 +/- 3.9 weeks, respectively, p < 0.001). The percentage of patients who achieved target BP in the combination approach group statistically exceeded that of the monotherapy treated one already after 2 weeks of treatment (30.5 vs. 14.9%, p < 0.01) and again after 4, 6, 8, and 10 weeks of treatment. Only at 12 weeks the percentage of normalized patients was similar in the two treatment groups (78.8% vs. 75.3%, ns). These results suggest that initial therapy with a V/A combination approach may be more quickly effective than a conventional sequential monotherapy approach in achieving target BP in hypertensive patients with metabolic syndrome.
authors.affiliation: Department of Internal Medicine and Therapeutics, Centro Ipertensione e Fisiopatologia Cardiovascolare, University of Pavia, Pavia, Italy. r.fogari@unipv.it
authors.forename: Roberto
authors.initials: R
authors.lastname: Fogari
authors.forename: Annalisa
authors.initials: A
authors.lastname: Zoppi
authors.forename: Ilaria
authors.initials: I
authors.lastname: Ferrari
authors.forename: Amedeo
authors.initials: A
authors.lastname: Mugellini
authors.forename: Paola
authors.initials: P
authors.lastname: Preti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Derosa
mesh_terms: D000368:Aged; D017311:Amlodipine / Q000009:adverse effects / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use; D001794:Blood Pressure / Q000502:physiology; D015897:Comorbidity; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology*; D008875:Middle Aged; D011446:Prospective Studies; D013777:Tetrazoles / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D014633:Valine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000068756:Valsartan
chemical_list: D000959:Antihypertensive Agents; D013777:Tetrazoles; D017311:Amlodipine; D000068756:Valsartan; D014633:Valine