Managing hypertension in high-risk patients: lessons and promises from the STRATHE and ADVANCE trials.

Bernard Waeber
{"title":"Managing hypertension in high-risk patients: lessons and promises from the STRATHE and ADVANCE trials.","authors":"Bernard Waeber","doi":"10.1097/01.hjh.0000229465.09610.b6","DOIUrl":null,"url":null,"abstract":"<p><p>Pharmacological treatment of hypertension represents a cost-effective way of preventing cardiovascular and renal complications. To benefit maximally from antihypertensive treatment, blood pressure should be brought to below 140/90 mmHg in every hypertensive patient, and even lower (< 130/80 mmHg) if diabetes or renal disease co-exists. Such targets cannot usually be reached using monotherapies. This is especially true in patients who present with a high cardiovascular risk. The co-administration of two agents acting by different mechanisms considerably increases the blood pressure control rate. Such combinations are not only efficacious, but are also well tolerated, and some fixed low-dose combinations even have a placebo-like tolerability. This is the case for the preparation containing the angiotensin-converting enzyme inhibitor perindopril (2 mg) and the diuretic indapamide (0.625 mg), a fixed low-dose combination that has been shown in controlled trials to be more effective than monotherapies in reducing albuminuria, regressing cardiac hypertrophy and improving the stiffness of large arteries. Using this combination to initiate antihypertensive therapy has been shown in a double-blind trial (Strategies of Treatment in Hypertension: Evaluation; STRATHE) to normalize blood pressure (< 140/90 mmHg) in significantly more patients (62%) than a sequential monotherapy approach based on atenolol, losartan and amlodipine (49%) and a stepped-care strategy based on valsartan and hydrochlorothiazide (47%), with no difference between the three arm groups in terms of tolerability. An ongoing randomized trial (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation; ADVANCE) is a study with a 2 x 2 factorial design assessing the effects of the fixed-dose perindopril-indapamide combination and of the intensive gliclazide modified release-based glucose control regimen in type 2 diabetic patients, with or without hypertension. A total of 11 140 patients were randomly selected. Within the first 6 weeks of treatment (run-in phase), the perindopril-indapamide combination lowered blood pressure from 145/81 +/- 22/11 mmHg (mean +/- SD) to 137/78 +/- 20/10 mmHg. Fixed-dose combinations are becoming more and more popular for the management of hypertension, and are even proposed by hypertension guidelines as a first-line option to treat hypertensive patients.</p>","PeriodicalId":16074,"journal":{"name":"Journal of hypertension. Supplement : official journal of the International Society of Hypertension","volume":"24 3","pages":"S19-27"},"PeriodicalIF":0.0000,"publicationDate":"2006-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/01.hjh.0000229465.09610.b6","citationCount":"11","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of hypertension. Supplement : official journal of the International Society of Hypertension","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/01.hjh.0000229465.09610.b6","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 11

Abstract

Pharmacological treatment of hypertension represents a cost-effective way of preventing cardiovascular and renal complications. To benefit maximally from antihypertensive treatment, blood pressure should be brought to below 140/90 mmHg in every hypertensive patient, and even lower (< 130/80 mmHg) if diabetes or renal disease co-exists. Such targets cannot usually be reached using monotherapies. This is especially true in patients who present with a high cardiovascular risk. The co-administration of two agents acting by different mechanisms considerably increases the blood pressure control rate. Such combinations are not only efficacious, but are also well tolerated, and some fixed low-dose combinations even have a placebo-like tolerability. This is the case for the preparation containing the angiotensin-converting enzyme inhibitor perindopril (2 mg) and the diuretic indapamide (0.625 mg), a fixed low-dose combination that has been shown in controlled trials to be more effective than monotherapies in reducing albuminuria, regressing cardiac hypertrophy and improving the stiffness of large arteries. Using this combination to initiate antihypertensive therapy has been shown in a double-blind trial (Strategies of Treatment in Hypertension: Evaluation; STRATHE) to normalize blood pressure (< 140/90 mmHg) in significantly more patients (62%) than a sequential monotherapy approach based on atenolol, losartan and amlodipine (49%) and a stepped-care strategy based on valsartan and hydrochlorothiazide (47%), with no difference between the three arm groups in terms of tolerability. An ongoing randomized trial (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation; ADVANCE) is a study with a 2 x 2 factorial design assessing the effects of the fixed-dose perindopril-indapamide combination and of the intensive gliclazide modified release-based glucose control regimen in type 2 diabetic patients, with or without hypertension. A total of 11 140 patients were randomly selected. Within the first 6 weeks of treatment (run-in phase), the perindopril-indapamide combination lowered blood pressure from 145/81 +/- 22/11 mmHg (mean +/- SD) to 137/78 +/- 20/10 mmHg. Fixed-dose combinations are becoming more and more popular for the management of hypertension, and are even proposed by hypertension guidelines as a first-line option to treat hypertensive patients.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
高危患者高血压管理:STRATHE和ADVANCE试验的经验教训和前景
高血压的药物治疗是预防心血管和肾脏并发症的一种经济有效的方法。为了最大限度地从降压治疗中获益,每位高血压患者的血压应降至140/90 mmHg以下,如果同时存在糖尿病或肾脏疾病,则应降至更低(< 130/80 mmHg)。使用单一疗法通常无法达到这些目标。对于心血管风险高的患者尤其如此。两种作用机制不同的药物联合用药可显著提高血压控制率。这样的组合不仅有效,而且耐受性良好,一些固定的低剂量组合甚至具有类似安慰剂的耐受性。含有血管紧张素转换酶抑制剂培哚普利(2mg)和利尿剂吲达帕胺(0.625 mg)的制剂就是这种情况,这是一种固定的低剂量组合,在对照试验中显示,在减少蛋白尿、缓解心脏肥厚和改善大动脉僵硬方面比单一疗法更有效。一项双盲试验(高血压治疗策略:评价;使血压(< 140/90 mmHg)正常化的患者(62%)明显多于基于阿替洛尔、氯沙坦和氨氯地平的序贯单药治疗方法(49%)和基于缬沙坦和氢氯噻嗪的分步治疗策略(47%),三个组在耐受性方面没有差异。一项正在进行的随机试验(糖尿病和血管疾病的作用:Preterax和Diamicron修饰的释放控制评价;ADVANCE)是一项2 × 2因子设计的研究,评估了固定剂量培哚普利-吲达帕胺联合治疗和强化格列齐特改良释放型血糖控制方案对伴有或不伴有高血压的2型糖尿病患者的影响。随机抽取11 140例患者。在治疗的前6周(磨合期),perindopril-indapamide联合用药将血压从145/81 +/- 22/11 mmHg(平均+/- SD)降至137/78 +/- 20/10 mmHg。固定剂量联合用药在高血压治疗中越来越受欢迎,甚至被高血压指南列为治疗高血压患者的一线选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
自引率
0.00%
发文量
0
期刊最新文献
Endothelial dysfunction in spontaneously hypertensive rats: focus on methodological aspects. Chronic antioxidant therapy fails to ameliorate hypertension: potential mechanisms behind. The protective effect of irbesartan in rats fed a high fat diet is associated with modification of leptin-adiponectin imbalance. Comparison of the effects of indapamide and captopril on the development of spontaneous hypertension. Hypertension and kidney alterations in rat offspring from low protein pregnancies.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1