Combination antihypertensive therapy in clinical practice. The analysis of 1254 consecutive patients with uncontrolled hypertension
Language English Country Great Britain, England Media print-electronic
Document type Journal Article, Research Support, Non-U.S. Gov't
PubMed
25833703
DOI
10.1038/jhh.2015.24
PII: jhh201524
Knihovny.cz E-resources
- MeSH
- Antihypertensive Agents therapeutic use MeSH
- Hypertension drug therapy MeSH
- Drug Therapy, Combination MeSH
- Practice Patterns, Physicians' statistics & numerical data MeSH
- Middle Aged MeSH
- Humans MeSH
- Retrospective Studies MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Czech Republic MeSH
- Names of Substances
- Antihypertensive Agents MeSH
The aim of the study was to analyze the clinical use of different types of combination therapy in a large sample of consecutive patients with uncontrolled hypertension referred to Hypertension Centre. We performed a retrospective analysis of combination antihypertensive therapy in 1254 consecutive patients with uncontrolled hypertension receiving at least triple-combination antihypertensive therapy. Among the most prescribed antihypertensive classes were renin-angiotensin blockers (96.8%), calcium channel blockers (82.5%), diuretics (82.0%), beta-blockers (73.0%), centrally acting drugs (56.0%) and urapidil (24.1%). Least prescribed were spironolactone (22.2%) and alpha-1-blockers (17.1%). Thiazide/thiazide-like diuretics were underdosed in more than two-thirds of patients. Furosemide was prescribed in 14.3% of patients treated with diuretics, while only indicated in 3.9%. Inappropriate combination therapy was found in 40.4% of patients. Controversial dual and higher blockade of renin-angiotensin system occurred in 25.2%. Incorrect use of a combination of two antihypertensive drugs with the similar mechanism of action was found in 28.1%, most commonly a combination of two drugs with central mechanism (13.5%). In conclusion, use of controversial or incorrect combinations of drugs in uncontrolled hypertension is common. Diuretics are frequently underdosed and spironolactone remains neglected in general practice. The improper combination of antihypertensive drugs may contribute to uncontrolled hypertension.
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N Engl J Med. 2012 Dec 6;367(23):2204-13 PubMed
Lancet. 2008 Aug 16;372(9638):547-53 PubMed
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BMJ Open. 2013 Aug 30;3(8):e003423 PubMed
Hypertension. 2010 Jan;55(1):147-52 PubMed
Eur J Cardiovasc Prev Rehabil. 2010 Oct;17(5):530-40 PubMed
J Hypertens. 2012 Aug;30(8):1656-64 PubMed
J Hum Hypertens. 2014 Nov;28(11):684-8 PubMed
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N Engl J Med. 2013 Nov 14;369(20):1892-903 PubMed
Adv Ther. 2010 Jul;27(7):426-43 PubMed
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Should All Patients with Resistant Hypertension Receive Spironolactone?
