title: Achieving blood preSsure goals sTudy in uncontrolled hypeRtensive pAtients treated with a fixed-dose combination of ramipriL/hydrochlorothiazide: the ASTRAL study.
abstract: BACKGROUND
  Hypertension is a common cardiovascular disease, affecting adults worldwide and it accounts for up to 30% of all deaths. The need for better control of arterial hypertension justifies observational studies designed to better understand the real-life management of hypertensive patients. The ASTRAL study was primarily designed to evaluate the percentage of hypertensive patients achieving blood pressure goals after eight weeks of treatment with a fixeddose combination of ramipril/hydrochlorothiazide (HCTZ).
  
  
  METHODS
  The study was a multi-centre, non-comparative, Open-label, observational study conducted in 36 centres in five sub-Saharan African countries, namely Cameroon, Congo Brazzaville, Democratic Republic of Congo (DRC), Madagascar and Nigeria. Four hundred and forty-nine men and women 18 years of age or older with hypertension not controlled by an ACE inhibitor, a diuretic or any other monotherapy or anti-hypertensive combination not containing a diuretic in a fixed dose were considered eligible for inclusion in this eight-week study. The study consisted of three visits, visit one (V1) at baseline, visit two (V2) after four weeks and visit three (V3) after eight weeks.
  
  
  RESULTS
  The mean age of the patients was 54.7 ± 11.7 years (20-90 years) and most were categorised by the WHO criteria as either overweight or obese (71.6%). After four and eight weeks of treatment with the study drug, systolic and diastolic blood pressures significantly changed from baseline: -24.7/-14.2 mmHg (p < 0.001) and -31.7/-17.9 mmHg (p < 0.001), respectively. There were 60.2% of the non-diabetics on prior monotherapy who, at eight weeks, fulfilled the primary blood pressure goal for SBP and DBP, versus 26.5% of the diabetic patients, also on monotherapy. Few adverse events were reported, with facial oedema and dry cough recurring twice in two patients.
  
  
  CONCLUSIONS
  Fixed-dose combination of ramipril/HCTZ is therefore effective, tolerable and has a good safety profile for blood pressure control in black Africans.
authors.affiliation: Division of Nephrology and Hypertension, Groote Schuur Hospital, University of Cape Town, South Africa. Ikechi.Okpechi@uct.ac.za
authors.forename: I G
authors.initials: IG
authors.lastname: Okpechi
authors.forename: H S
authors.initials: HS
authors.lastname: Schoeman
authors.forename: B
authors.initials: B
authors.lastname: Longo-Mbenza
authors.forename: D A
authors.initials: DA
authors.lastname: Oke
authors.forename: S
authors.initials: S
authors.lastname: Kingue
authors.forename: J L
authors.initials: JL
authors.lastname: Nkoua
authors.forename: B L
authors.initials: BL
authors.lastname: Rayner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D003925:Diabetic Angiopathies / Q000188:drug therapy / Q000453:epidemiology; D004338:Drug Combinations; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage*; D006973:Hypertension / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017257:Ramipril / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D004338:Drug Combinations; D006852:Hydrochlorothiazide; D017257:Ramipril