title: Single-pill combination therapy in the initial treatment of marked hypertension: a propensity-matched analysis.
abstract: BACKGROUND
  Many drugs combinations are available and equally recommended for the initial treatment of patients with marked blood pressure (BP) elevation and high cardiovascular risk.
  
  
  OBJECTIVE
  To investigate safety and efficacy of such combination therapies.
  
  
  METHODS
  Prospectively collected data were retrospectively reviewed, inclusion criteria were: initial single-pill combination therapy, availability of clinical and echocardiographic 6-month follow-up. Six treatment groups were identified: Enalapril 20 mg+ Hydrochlorothiazide 12.5 mg (E/H), E 20 mg + Lercanidipine 10 mg (E/L), Ramipril 2.5 mg+ H 12.5 mg (R/H), Perindopril 5 mg+ Amlodipine 5 mg (P/A), Olmesartan 40 mg+ H 12.5 mg (O/H) and Telmisartan 40 mg+ H 12.5 mg (T/H). To avoid selection bias a Propensity score (goodness of fit: c-statistic 0.78, p = 0.0001) was used to select comparable cohorts of patients (n = 142 each).
  
  
  RESULTS
  After 4 weeks of treatment BP goal was achieved by 624/852 (73.2%) patients, and adverse events were registered in 24/852 (2.8%) patients. After 6 months, 562/624 (90.1%) patients maintained the BP goal. Six-month responder rate was significantly higher in the E/L (69.0%) and P/A (68.3%) groups (p = 0.05); especially among diabetics (52.0% and 51.0%, respectively; p = 0.003). Patients receiving E/L (-19.8 ± 3.2 mmHg) and P/A (-19.9 ± 4.6 mmHg) showed greater reductions of diastolic BP (p = 0.03); whereas reductions of systolic BP were similar between treatment groups (p = 0.46). Echocardiographic follow-up revealed greater left ventricular reverse remodeling among patients receiving ACE-inhibitors (E/L, R/H, E/H and P/A), but this trend did not reach statistical significance.
  
  
  CONCLUSIONS
  Single-pill fixed-dose combination therapies are highly effective and safe in the study settings. Best clinical and echocardiographic outcomes were noted among patients receiving E/L, R/H and P/A.
authors.affiliation: Department of Cardiovascular Pathophysiology and Imaging, Sapienza, University of Rome , Rome , Italy and.
authors.forename: Emiliano
authors.initials: E
authors.lastname: Angeloni
authors.forename: Angelo
authors.initials: A
authors.lastname: Vitaterna
authors.forename: Paola
authors.initials: P
authors.lastname: Lombardo
authors.forename: Michele
authors.initials: M
authors.lastname: Pirelli
authors.forename: Simone
authors.initials: S
authors.lastname: Refice
mesh_terms: D017311:Amlodipine / Q000008:administration & dosage; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001562:Benzimidazoles / Q000008:administration & dosage; D001565:Benzoates / Q000008:administration & dosage; D001794:Blood Pressure / Q000187:drug effects*; D004095:Dihydropyridines; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D004656:Enalapril / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D007093:Imidazoles / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D020913:Perindopril / Q000008:administration & dosage; D057216:Propensity Score; D017257:Ramipril / Q000008:administration & dosage; D012189:Retrospective Studies; D012307:Risk Factors; D000077333:Telmisartan; D013777:Tetrazoles / Q000008:administration & dosage
chemical_list: D000959:Antihypertensive Agents; D001562:Benzimidazoles; D001565:Benzoates; D004095:Dihydropyridines; D004338:Drug Combinations; D007093:Imidazoles; D013777:Tetrazoles; D006852:Hydrochlorothiazide; D017311:Amlodipine; D004656:Enalapril; C437965:olmesartan; D017257:Ramipril; D000077333:Telmisartan; C060343:lercanidipine; D020913:Perindopril
keywords: Blood pressure control; combination therapy; hypertension