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Hypertension
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my personal edition > hypertension > news
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DGDispatch
Amlodipine Alone or in Combination With Other Drugs Reduces Systolic Blood Pressure: Presented at ASH(HYP)
By Jill Stein
NEW YORK, NY -- May 21, 2003 -- The use of amlodipine alone or in combination with other medications significantly decreases systolic blood pressure, irrespective of prior treatment regimens.
Trent McLaughlin, PhD, with NDC Health, Phoenix, Ariz, and associates examined the efficacy of amlodipine as monotherapy or in combination with other agents within a multicenter ambulatory care setting for control of systolic blood pressure levels, and for attainment of goals set by the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI).
Dr. McLaughlin reported the results here on May 17th at the 18th Annual Scientific Meeting of the American Society of Hypertension.
"There is a large number of uncontrolled hypertensive patients, in most cases because of elevated systolic blood pressure readings," Dr. McLaughlin said. "Systolic blood pressure is difficult to control, often requiring multiple medications. Systolic blood pressure control is important for improving cardiovascular outcome."
Few studies have previously compared antihypertensive medications as monotherapy, or as part of multi-drug regimens in a real world clinical practice.
For this trial, hypertensive adults were identified over a 4-year period using the International Classification of Diseases Ninth Revision codes from a large database of 360000 primary care patients in the US. To be eligible for inclusion, patient records had to include at least one blood pressure measurement from 6 months before to 12 months after the index date of amlodipine use.
Of the 10481 patients who initiated therapy with amlodipine during the study period, 1174 met all inclusion criteria.
More than one-third of patients in the final sample received amlodipine as first- line therapy, while roughly half of the sample was on 1 or 2 antihypertensive medications at baseline.
After controlling for differences in baseline characteristics, the mean change in systolic and diastolic blood pressure levels was fairly consistent among all patients, regardless of baseline regimen. The mean reduction in systolic blood pressure was approximately 17 mm Hg, while diastolic blood pressure decreased an average of 8 mm Hg, irrespective of regimen.
Adding amlodipine to an ACE-inhibitor /angiotensin receptor blocker and diuretic treatment regimen was shown to provide additional systolic blood pressure reduction, up to 20 mm Hg.
Over 40% of patients achieved the target JNC VI blood pressure goal during the study period. Patients treated previously with a diuretic were most likely to achieve their blood pressure goal.
Dr. McLaughlin said that a limitation of the study was that the results are based on several large general physician practices, and may not be generalizable to other populations. In addition, patient compliance to medications was not known.
[Study title: Impact of Amlodipine Alone or as Add-on Therapy on Systolic Blood Pressure Reduction and JNC VI Goal Attainment. Abstract P-237]
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