Reductions in blood pressure and lipid parameters are generally lower than those previously projected , though substantial heterogeneity of results exists .
Fixed-dose combination therapy is associated with modest increases in adverse events compared with placebo , single drug active component , or usual care but may be associated with improved adherence to a multidrug regimen .
BACKGROUND Cardiovascular disease ( CVD ) is the leading cause of death and disability worldwide , yet CVD risk factor control and secondary prevention rates remain low .
A fixed-dose combination of blood pressure and cholesterol lowering and antiplatelet treatments into a single pill , or polypill , has been proposed as one strategy to reduce the global burden of CVD by up to 80 % given its potential for better adherence and lower costs .
OBJECTIVES To determine the effectiveness of fixed-dose combination therapy on reducing fatal and non-fatal CVD events and on improving blood pressure and lipid CVD risk factors for both primary and secondary prevention of CVD .
We also aim ed to determine discontinuation rates , adverse events , health-related quality of life , and costs of fixed-dose combination therapy .
Antihypertensive efficacy of hydrochlorothiazide vs chlorthalidone combined with azilsartan medoxomil.
BACKGROUND Chlorthalidone has proven efficacy to reduce cardiovascular morbidity and mortality , yet it is infrequently used in practice . This study provides a direct comparison of chlorthalidone with hydrochlorothiazide , each combined with the angiotensin receptor blocker azilsartan medoxomil , on blood pressure reduction and control rates . METHODS This is a r and omized , double-blind , titrate-to-target blood pressure trial comparing the single-pill combination of azilsartan medoxomil and chlorthalidone versus co-administration of azilsartan medoxomil and hydrochlorothiazide in participants with stage 2 primary hypertension . After 2 weeks of treatment with azilsartan medoxomil 40 mg alone , all participants also received 12.5 mg of diuretic for 4 weeks ( up to week 6 ) and were titrated to 25 mg for another 4 weeks ( up to week 10 ) if they failed to achieve target blood pressure . The primary end point was change in clinic systolic blood pressure . Target blood pressure was defined as clinic blood pressure < 140/90 mm Hg for participants without diabetes or chronic kidney disease or < 130/80 mm Hg for participants with diabetes or chronic kidney disease . RESULTS The mean age of the 609 participants was 56.4 years , and the mean baseline clinic blood pressure was 164.6/95.4 mm Hg . The primary end point analysis at week 6 demonstrated a greater reduction of clinic systolic blood pressure for the chlorthalidone ( -35.1 mm Hg ) versus hydrochlorothiazide combination ( -29.5 mm Hg ) ( mean difference , -5.6 mm Hg ; 95 % confidence interval , -8.3 to -2.9 ; P < .001 ) . The mean difference in 24-hour ambulatory systolic blood pressure at week 6 was -5.8 mm Hg ( 95 % confidence interval , -8.4 to -3.2 ; P < .001 ) , favoring the azilsartan medoxomil/chlorthalidone group . The percentage of participants achieving target clinic blood pressure at week 6 was greater for the chlorthalidone versus hydrochlorothiazide combination ( 64.1 % vs 45.9 % , P < .001 ) . Drug discontinuations due to adverse events were not statistically significantly different between groups ( 9.3 % vs 7.3 % , P = .38 ) , and hypokalemia was uncommon in both groups . CONCLUSIONS Chlorthalidone combined with azilsartan medoxomil provides better blood pressure reduction and a higher likelihood of achieving blood pressure control than hydrochlorothiazide combined with azilsartan medoxomil . This benefit occurred without a difference in safety measurements
Reductions in blood pressure and lipid parameters are generally lower than those previously projected , though substantial heterogeneity of results exists .
Fixed-dose combination therapy is associated with modest increases in adverse events compared with placebo , single drug active component , or usual care but may be associated with improved adherence to a multidrug regimen .
BACKGROUND Cardiovascular disease ( CVD ) is the leading cause of death and disability worldwide , yet CVD risk factor control and secondary prevention rates remain low .
A fixed-dose combination of blood pressure and cholesterol lowering and antiplatelet treatments into a single pill , or polypill , has been proposed as one strategy to reduce the global burden of CVD by up to 80 % given its potential for better adherence and lower costs .
OBJECTIVES To determine the effectiveness of fixed-dose combination therapy on reducing fatal and non-fatal CVD events and on improving blood pressure and lipid CVD risk factors for both primary and secondary prevention of CVD .
We also aim ed to determine discontinuation rates , adverse events , health-related quality of life , and costs of fixed-dose combination therapy .