title: Combination therapy as initial treatment for newly diagnosed hypertension.
abstract: BACKGROUND
  The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends that clinicians consider the use of multidrug therapy to increase likelihood of achieving blood pressure goal. Little is known about recent patterns of combination antihypertensive therapy use in patients being initiated on hypertension treatment.
  
  
  METHODS
  We investigated combination antihypertensive therapy use in newly diagnosed hypertensive patients from the Cardiovascular Research Network Hypertension Registry. Multivariable logistic regression was used to assess the relationship between combination antihypertensive therapy and 12-month blood pressure control.
  
  
  RESULTS
  Between 2002 and 2007, a total of 161,585 patients met criteria for incident hypertension and were initiated on treatment. During the study period, an increasing proportion of patients were treated initially with combination rather than with single-agent therapy (20.7% in 2002 compared with 35.8% in 2007, P < .001). This increase in combination therapy use was more pronounced in patients with stage 2 hypertension, whose combination therapy use increased from 21.6% in 2002 to 44.5% in 2007. Nearly 90% of initial combination therapy was accounted for by 2 combinations, a thiazide and a potassium-sparing diuretic (47.6%) and a thiazide and an angiotensin-converting enzyme inhibitor (41.4%). After controlling for relevant clinical factors, including subsequent intensification of treatment and medication adherence, combination therapy was associated with increased odds of blood pressure control at 12 months (odds ratio compared with single-drug initial therapy 1.20; 95% CI 1.15-1.24, P < .001).
  
  
  CONCLUSIONS
  Initial treatment of hypertension with combination therapy is increasingly common and is associated with better long-term blood pressure control.
authors.affiliation: Department of Medicine, University of Colorado, School of Medicine, Aurora, USA. brian.byrd@ucdenver.edu
authors.forename: James B
authors.initials: JB
authors.lastname: Byrd
authors.forename: Chan
authors.initials: C
authors.lastname: Zeng
authors.forename: Heather M
authors.initials: HM
authors.lastname: Tavel
authors.forename: David J
authors.initials: DJ
authors.lastname: Magid
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: O'Connor
authors.forename: Karen L
authors.initials: KL
authors.lastname: Margolis
authors.forename: Joe V
authors.initials: JV
authors.lastname: Selby
authors.forename: P Michael
authors.initials: PM
authors.lastname: Ho
mesh_terms: D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects* / Q000235:genetics; D003935:Diagnostic Techniques, Cardiovascular; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents