Initial combination therapy
reduces the risk of
cardiovascular events in
hypertensive patients
Gradman AH, Parisé H, Lefebvre P, Falvey H, Lafeuille MH, Duh MS.
Hypertension. 2013;61:309-318.
Study design
 Retrospective cohort study
 Electronic data charts from 2005 to 2009
 Patients:
• adult
• uncontrolled blood pressure
• newly initiated on antihypertensive therapy (ACE
inhibitors, CCBs, ARBs, or diuretics) given as a
monotherapy or a drug combination (fixed or free)
• exclusion of patients with history of CV event
 Baseline period of 90 days before the treatment
initiation
Gradman AH, Parisé H, Lefebvre P, Falvey H, Lafeuille MH, Duh MS. Hypertension. 2013;61:309-318.
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Study end points
 Risk of CV events or all-cause death
•
•
•
•
acute MI
stroke/transient ischemic attack
hospitalization for heart failure
all-cause deaths
 Time to BP goal attainment
 Rates of health care resource use
Gradman AH, Parisé H, Lefebvre P, Falvey H, Lafeuille MH , Duh MS. Hypertension. 2013;61:309-318.
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Main results
 3309 Patients initiating monotherapy and
subsequently switched to combination
therapy (add-on cohort)
• combination therapy prescribed at a median
13.5 months after treatment initiation
 1808 Patients initiating combination
therapy
• 1762 patients matched the add-on cohort
 Study population: 1762 x 2 = 3524 patients
• 67% stage 1 hypertension
• 33% stage 2 hypertension
Gradman AH, Parisé H, Lefebvre P, Falvey H, Lafeuille MH, Duh MS. Hypertension. 2013;61:309-318.
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34% Risk reduction for CV events or all-cause death
with initiating combination therapy
Gradman AH, Parisé H, Lefebvre P, Falvey H, Lafeuille MH, Duh MS. Hypertension. 2013;61:309-318.
5
Significant shorter median time to achieved BP
target in the combination therapy
Gradman AH, Parisé H, Lefebvre P, Falvey H, Lafeuille MH, Duh MS. Hypertension. 2013;61:309-318.
6
Among patients achieving the BP target, a
majority is without CV event during follow-up
Gradman AH, Parisé H, Lefebvre P, Falvey H, Lafeuille MH, Duh MS. Hypertension. 2013;61:309-318.
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Interrelationship among exposure group, BP goal
attainment, and CV events
 Achieving target BP after treatment initiation was
associated with a statistically significant risk reduction
of 23% for CV events or all-cause death
 The results indicated that an SBP >160 mm Hg at the
last reading was associated with a 2.2-fold increased
risk of developing a CV event or death compared with
an SBP reading of 120 to 139 mm Hg
 Increase of 1 mm Hg in SBP was associated with a 2%
increased risk of having a CV event
Gradman AH, Parisé H, Lefebvre P, Falvey H, Lafeuille MH, Duh MS. Hypertension. 2013;61:309-318.
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Conclusion
 Initial combination therapy was
associated with a significant risk
reduction in cardiovascular events.
 More rapid achievement of target BP was
found to be the main contributor to the
estimated risk reduction.
Gradman AH, Parisé H, Lefebvre P, Falvey H, Lafeuille MH, Duh MS. Hypertension. 2013;61:309-318.
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