Estimated impact of guidelines-based initiation of dual antihypertensive therapy on long-term cardiovascular outcomes in 1.1 million individuals

作者：António Coca, Claudio Borghi, George S. Stergiou, Irfan Khan, Alexandra Koumas, Jacques Blacher, Mohamed Abdel-Moneim · 发表于：European Heart Journal - Cardiovascular Pharmacotherapy · 年份：2024 · DOI：10.1093/ehjcvp/pvae048 · 被引用次数：8 · 研究领域：Blood Pressure and Hypertension Studies、Medication Adherence and Compliance、Diabetes Treatment and Management

AIMS: Guidelines recommend initiation of dual combination antihypertensive therapy, preferably single-pill combination (SPC), in most patients with hypertension. Evidence on narrowing gaps in clinical practice relative to guidelines is limited. METHODS AND RESULTS: Monte Carlo simulation was applied to 1.1 million patients qualifying for dual combination therapy from a previously conducted retrospective analysis of clinical practice, hospital statistics, and national statistics in the UK. We provide 10-year Kaplan-Meier event rates for the primary endpoint representing a composite of non-fatal myocardial infarction, non-fatal stroke (ischaemic or haemorrhagic), non-fatal heart failure hospitalization, or cardiovascular death. Cox model results from a previously conducted study were utilized to estimate baseline risk, together with evidence on risk reduction from the Blood Pressure Lowering Treatment Trialists' Collaboration (BPLTTC) meta-analysis and published evidence on blood pressure-lowering efficacy of antihypertensive therapies. In the overall population, estimated 10-year event rates for the primary endpoint in patients with 100% persistence in monotherapy were 17.0% for irbesartan and 17.6% for ramipril. These rates were only modestly better than those observed in clinical practice (17.8%). In patients with 100% persistence in dual therapy, estimated event rates were 13.6% for combinations of irbesartan + amlodipine [absolute risk reduction (ARR) = 8.7% compared with ...