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Managing hypertension in high-risk patients: lessons and promises from the STRATHE and ADVANCE trials.
J Hypertens Suppl 2006; 24(3):S19-27JH

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.

Authors+Show Affiliations

Division of Clinical Pathophysiology, University Hospital, Lausanne, Switzerland. bernard.waeber@chuv.ch

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

16723862

Citation

Waeber, Bernard. "Managing Hypertension in High-risk Patients: Lessons and Promises From the STRATHE and ADVANCE Trials." Journal of Hypertension. Supplement : Official Journal of the International Society of Hypertension, vol. 24, no. 3, 2006, pp. S19-27.
Waeber B. Managing hypertension in high-risk patients: lessons and promises from the STRATHE and ADVANCE trials. J Hypertens Suppl. 2006;24(3):S19-27.
Waeber, B. (2006). Managing hypertension in high-risk patients: lessons and promises from the STRATHE and ADVANCE trials. Journal of Hypertension. Supplement : Official Journal of the International Society of Hypertension, 24(3), pp. S19-27.
Waeber B. Managing Hypertension in High-risk Patients: Lessons and Promises From the STRATHE and ADVANCE Trials. J Hypertens Suppl. 2006;24(3):S19-27. PubMed PMID: 16723862.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Managing hypertension in high-risk patients: lessons and promises from the STRATHE and ADVANCE trials. A1 - Waeber,Bernard, PY - 2006/5/26/pubmed PY - 2006/10/27/medline PY - 2006/5/26/entrez SP - S19 EP - 27 JF - Journal of hypertension. Supplement : official journal of the International Society of Hypertension JO - J Hypertens Suppl VL - 24 IS - 3 N2 - 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. SN - 0952-1178 UR - https://www.unboundmedicine.com/medline/citation/16723862/Managing_hypertension_in_high_risk_patients:_lessons_and_promises_from_the_STRATHE_and_ADVANCE_trials_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&amp;PAGE=linkout&amp;SEARCH=16723862.ui DB - PRIME DP - Unbound Medicine ER -