title: Benefit of initial dual-therapy on stroke prevention in Chinese hypertensive patients: a real world cohort study.
abstract: OBJECTIVE
  Studies have shown that combination anti-hypertensive therapy is superior to mono-therapy in blood pressure control and prevention of cardiovascular events. However, whether such advantage exists in the prevention of stroke in Chinese hypertensive patients remains unclear. This study aimed to compare the impact of initial combination versus mono-therapy on stroke events in a large cohort of Chinese hypertensive patients.
  
  
  RESULTS
  Hypertensive patients with uncontrolled blood pressure and without a history of stroke were screened from the Shanghai Community-dwelling Hypertensive Population Follow-up Database. Based on the initial treatment, individuals were divided into an initial mono-therapy group and initial dual combination group. Patients were followed for 42 months. 32,682 and 4,926 patients were included in the initial mono- and dual-therapy group. The achieved target blood pressure control rates of mono vs. combination groups at 6, 12, 24, and 42 months of follow-up, were 59.47% vs. 60.05%, 78.23% vs. 77.06%, 85.51% vs. 84.02%, and 86.90% vs. 85.44%, respectively. Their corresponding incidence densities of stroke were 0.792 vs. 0.489, 1.49 vs. 1.15, 2.79 vs. 2.38, and 4.25 vs. 4.32 (cases per 100 person-year), respectively. The 6-month incidence of stroke in dual-therapy group was significantly lower than mono-therapy group (adjusted HR 0.64; 95% CI: 0.30-0.93). However, no significant group differences in the incidence density were observed at 12, 24, and 42 months.
  
  
  CONCLUSIONS
  Our study demonstrates that, for patients with uncontrolled hypertension, initial dual therapy is more effective in the prevention of stroke during the first 6 months of treatment, but not thereafter. Combination antihypertensive therapy may be a beneficial initial strategy for early stroke prevention.
authors.affiliation: 1 Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China ; 2 Medical Affairs of Great China Region of Novartis, Shanghai 201101, China ; 3 Shanghai Minhang Center for Disease Control and Prevention, Shanghai 201101, China.
authors.forename: Jin-Ming
authors.initials: JM
authors.lastname: Yu
authors.affiliation: 1 Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China ; 2 Medical Affairs of Great China Region of Novartis, Shanghai 201101, China ; 3 Shanghai Minhang Center for Disease Control and Prevention, Shanghai 201101, China.
authors.forename: Qun-Yu
authors.initials: QY
authors.lastname: Kong
authors.affiliation: 1 Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China ; 2 Medical Affairs of Great China Region of Novartis, Shanghai 201101, China ; 3 Shanghai Minhang Center for Disease Control and Prevention, Shanghai 201101, China.
authors.forename: Tian
authors.initials: T
authors.lastname: Shen
authors.affiliation: 1 Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China ; 2 Medical Affairs of Great China Region of Novartis, Shanghai 201101, China ; 3 Shanghai Minhang Center for Disease Control and Prevention, Shanghai 201101, China.
authors.forename: Yu-Song
authors.initials: YS
authors.lastname: He
authors.affiliation: 1 Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China ; 2 Medical Affairs of Great China Region of Novartis, Shanghai 201101, China ; 3 Shanghai Minhang Center for Disease Control and Prevention, Shanghai 201101, China.
authors.forename: Ji-Wei
authors.initials: JW
authors.lastname: Wang
authors.affiliation: 1 Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China ; 2 Medical Affairs of Great China Region of Novartis, Shanghai 201101, China ; 3 Shanghai Minhang Center for Disease Control and Prevention, Shanghai 201101, China.
authors.forename: Yan-Ping
authors.initials: YP
authors.lastname: Zhao
keywords: Hypertension; combination-therapy; dual-therapy; mono-therapy; stroke