P-85: Mean blood pressure improvement with combination therapy versus concomitant antihypertensive agents

Antihypertensive treatment with two or more agents has been proven superior compared to monotherapy. JNC VI advocates combinations of low doses of two agents from different classes to provide additional antihypertensive efficacy, thereby minimizing the likelihood of dose-dependent adverse effects. The aim of this retrospective study was to test whether patients with hypertension (HTN) in a managed care organization had better mean BP when receiving a fixed combination dihydropyridine calcium channel blocker (DHP-CCB)/angiotensin-converting enzyme inhibitor (ACEI) versus high dose DHP-CCB or DHP-CCB and ACEI concurrently. Ninety-three (93) patients currently receiving a DHP-CCB/ACEI combination for at least 60 days and had previously received either a DHP-CCB and ACEI as separate concurrent antihypertensives or a high dose DHP-CCB were included in this study. Each patient served as his/her own control in this pre- post- analysis. The pre-combination BP was the last office BP documented before fixed combination therapy was initiated. After receiving the combination antihypertensive for at least 60 days, the most recent BP was then documented. Data was analyzed using t-test. Average age was 61.3 years and 48.4% were female. Mean pre- and post- BP readings were 145.6/86.5 mmHg and 138.7/82.6 mmHg, respectively. The differences were statistically significant (p < .005). (See Table)Results Comparing Mean BP for Pre and Post Combination Therapy PARAMETER c Mean BP SD p-value Pre-combination SBP 93 145.6 16.9 Post-combination SBP 93 138.7 16.1 0.0018 Pre-combination DBP 93 86.5 11.2 Post-combination DBP 93 82.6 10.3 0.0034 Our results suggest that mean BP is reduced when a fixed combination DHP-CCB/ACEI antihypertensive is used to substitute for a high dose DHP-CCB or DHP-CCB and ACEI concurrently in a managed care patient population with HTN.