PS-C20-6: SINGLE-PILL COMBINATION ENABLES FAST TARGET BP ACHIEVEMENT. (January 2023)

• Record Type: Journal Article
• Authors: Brguljan, Jana; Chazova, Irina E; Gaciong, Zbigniew; Simic, Dragan; Vajer, Peter; Zelveian, Parounak Harutyun; Jelakovic, Bojan
• Is Part Of: Journal of hypertension. Volume 41(2023)Supplement 1
• Page Start: e394
• Page End: e395
• Publication Date: 2023-01
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000916860.25615.9f
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: To assess the treatment response and time to reaching the target clinical blood pressure (BP) with the single-pill combinations (SPCs) of perindopril/amlodipine (P/A) and perindopril/amlodipine/indapamide (P/A/I) in naïve and uncontrolled hypertensive patients. Design and method: 440 adults with essential hypertension were assessed in the 16-week interventional, open-label, prospective, international, multicentre trial PRECIOUS. Office BP was measured with a validated automated BP-measuring device by qualified health professionals following guidelines protocol. At inclusion, naïve or patients uncontrolled on previous mono or dual therapy other than perindopril and amlodipine were assigned to dual SPC arm with initial dose of 4/5 mg P/A. Those uncontrolled on previous dual or triple therapy were assigned to triple SPC arm with initial dose of 4/5/1.25 mg P/A/I. If not reaching office BP control, initial dose was up titrated in 4-week intervals to 8/5 mg, 8/10 mg P/A or 8/10/2.5 mg P/A/I in dual SPC arm and to 8/5/2.5 mg or 8/10/2.5 mg P/A/I in triple SPC arm. Results: In the first 4-week interval, 43.6% of the FAS population reached the target BP with a significant decrease by -16.1/-10.1 mmHg from the mean baseline office BP of 157.0/98.1 mmHg (p < 0.001). The proportion of patients reaching BP control increased after each up-titration interval to 63.9%, 78.0% and 79.8% after 8, 12 and 16 weeks, respectively. The mean BP values decreased further till the end of the trial, reaching the mean BP value of 128.1/81.1 mmHg after 16 weeks. Interestingly, in subgroup of patients who did not need up-titration (n = 154), a decrease of -24.2/-16.2 mmHg (-15.4%/-16.3%) was already achieved in the first 4 weeks and grew moderately to -28.2/-17.7 mmHg (-18.1%/-17.9%) till the end of the trial. On the other hand, in the first 4 weeks, in subgroup of patients who needed up-titration (n = 274) the decrease was a moderate -11.8/-6.9 mmHg (-7.1%/-6.6%), but grew with every up-titration step at the same pace to reach a decrease of -28.4/-16.7 mmHg (-17.6%/-16.4%) at the end of the trial. Conclusions: In only 4 weeks 43.6% of patients who responded to the initially prescribed therapy achieved target BP, exhibiting more than 2x bigger BP decrease than non-responders who needed further intensification of therapy. BP decrease from the baseline was similar in both groups, however following a different pattern. At the end of the trial, almost 80% of patients reached BP control with the SPC treatment strategy.