Combination Therapy Bests Monotherapy for BP Control

Patients experience greater blood pressure drop with aliskiren, amoldipine taken together initially

THURSDAY, Jan. 13 (HealthDay News) -- In individuals with high blood pressure, a combination drug therapy given initially appears to result in better blood pressure control than monotherapy, and patients who undergo the two-drug treatment after taking the single-drug therapy also experience better blood pressure outcomes, though not at the same level as those who began with the combination treatment, according to research published online Jan. 13 in The Lancet.

Morris J. Brown, of the University of Cambridge in the United Kingdom, and colleagues analyzed the outcomes of 315 patients randomly assigned to aliskiren, 315 to amlodipine, and 617 to a combination of the two. All patients received combination therapy starting at week 16 of the 32-week trial. All patients enrolled had essential hypertension, were aged 18 years or older, and had systolic blood pressure between 150 and 180 mm Hg.

The researchers found that patients on combination therapy had a greater reduction in mean systolic blood pressure than the monotherapy groups by 6.5 mm Hg (P < 0.0001). By week 24, when all patients were receiving combination therapy, the difference between groups had fallen to 1.4 mm Hg (P = 0.059).

"Our findings show that patients randomly assigned to initial combination treatment with both aliskiren and amlodipine had substantially better mean blood pressure reduction over the first 24 weeks than did patients starting on either drug as monotherapy, with no cost in adverse events or withdrawals. Once the monotherapy patients progressed to combination therapy, their blood pressure fell towards, but never numerically caught up with, that of the initial combination group," the authors write.

The trial was funded by Novartis Pharma AG; several authors disclosed financial relationships with the company.

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