Single pill therapy better for high BP: Study

Toronto, March 20: Contrary to multi-drug regime often followed to achieve optimum blood pressure (BP) levels, low doses of single pill may prove more effective, a new Canadian study suggests.

Evidence suggests that reduction of the blood pressure by 5-6 mmHg can snap the risk of stroke by 40 percent and of coronary heart disease by 25 percent. As each added drug helped lower systolic blood pressuredefine (the upper reading indicating the peak pressure in the arteries when the heart beats) by 5-10 mmHg, multiple drug therapy was believed to achieve better results.

However, the latest study, called the 'Simplified Treatment Intervention to Control Hypertension (STITCH), discounts past evidences suggesting that single pill may prove more effective in blood pressure management.

For the study, Ross D. Feldman, a clinical scientist with at the University of Western Ontario, and colleagues recruited 2,104 patients diagnosed with high blood pressure between Feb. 2005 and Jan. 2007.

For six months, the participants were randomly assigned to follow the STITCH algorithm, or to continue with usual blood pressure management according to Canadian Hypertension Education Program (CHEP) guidelines.

The STITCH algorithm consisted of 4 steps: (1) initial therapy with a half tablet of a low-dose angiotensin-converting enzyme inhibitor/diuretic or angiotensin receptor blocker/diuretic combination; (2) up-titration of combination therapy successively to the highest dose supplied; (3) addition of a calcium channel blocker and up-titration; and (4) addition of one of the non–first-line antihypertensive agents.

For non-diabetics, the optimum blood pressure level was fixed at 140/90 mmHg), while for diabetics, researchers targeted a level of 120/80mmHg.

Follow-up results revealed that simplified antihypertensive algorithm, using initial low-dose, fixed-dose combination therapy, was more effective in achieving optimum blood pressure levels than the pronounced guideline-based practice for the management of hypertension.

“The nature of hypertension management has changed. It is much more aggressive, and complex, leading to hundreds of recommendations on how to manage high blood pressure,” Feldman wrote.

"This should be a call to hypertensive patients to go to their family physicians and be prescribed these single pill combinations. It makes both the patients' and doctors' lives easier" he added.

The results feature in the April issue of journal Hypertension.