How to Intensify Treatment in Older Patients With Hypertension: Is There a Single Answer?
Authors: Olivier Steichen
Journal: Annals of Internal Medicine (2021)

EditorialsDecember 2021How to Intensify Treatment in Older Patients With Hypertension: Is There a Single Answer?Olivier Steichen, MD, PhDOlivier Steichen, MD, PhDAssistance Publique-Hôpitaux de Paris and Sorbonne Université, Paris, FranceSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M21-3648 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Randomized trials show that half-dose dual combination therapies for hypertension reduce blood pressure (BP) more than full-dose monotherapies, with no more adverse effects (1). Indeed, combining 2 drugs has an additive effect on BP reduction, whereas increasing the dose of a drug is less than additive (2): A half dose is only 25% less potent than a full dose. Under these assumptions, the expected potency of antihypertensive drug combinations can be approximated (Table). For example, the combination of 2 drugs at half dose is expected to be 50% more potent than a single drug at full dose. Using half doses ...References1. Salam A, Kanukula R, Atkins E, et al. Efficacy and safety of dual combination therapy of blood pressure-lowering drugs as initial treatment for hypertension: a systematic review and meta-analysis of randomized controlled trials. J Hypertens. 2019;37:1768-1774. [PMID: 30986788] doi:10.1097/HJH.0000000000002096 CrossrefMedlineGoogle Scholar2. Law MR, Wald NJ, Morris JK, et al. Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials. BMJ. 2003;326:1427. [PMID: 12829555] CrossrefMedlineGoogle Scholar3. Parati G, Kjeldsen S, Coca A, et al. Adherence to single-pill versus free-equivalent combination therapy in hypertension: a systematic review and meta-analysis. Hypertension. 2021;77:692-705. [PMID: 33390044] doi:10.1161/HYPERTENSIONAHA.120.15781 CrossrefMedlineGoogle Scholar4. Corrao G, Parodi A, Zambon A, et al. Reduced discontinuation of antihypertensive treatment by two-drug combination as first step. Evidence from daily life practice. J Hypertens. 2010;28:1584-90. [PMID: 20543716] doi:10.1097/HJH.0b013e328339f9fa CrossrefMedlineGoogle Scholar5. Egan BM, Bandyopadhyay D, Shaftman SR, et al. Initial monotherapy and combination therapy and hypertension control the first year. Hypertension. 2012;59:1124-31. [PMID: 22566499] doi:10.1161/HYPERTENSIONAHA.112.194167 CrossrefMedlineGoogle Scholar6. Gradman AH, Parisé H, Lefebvre P, et al. Initial combination therapy reduces the risk of cardiovascular events in hypertensive patients: a matched cohort study. Hypertension. 2013;61:309-18. [PMID: 23184383] doi:10.1161/HYPERTENSIONAHA.112.201566 CrossrefMedlineGoogle Scholar7. Rea F, Corrao G, Merlino L, et al. Early cardiovascular protection by initial two-drug fixed-dose combination treatment vs. monotherapy in hypertension. Eur Heart J. 2018;39:3654-3661. [PMID: 30060044] doi:10.1093/eurheartj/ehy420 CrossrefMedlineGoogle Scholar8. Aubert CE, Sussman JB, Hofer TP, et al. Adding a new medication versus maximizing dose to intensify hypertension treatment in older adults. A retrospective observational study. Ann Intern Med. 2021;174:1666-73. doi:10.7326/M21-1456 Google Scholar9. Conen D, Aeschbacher S, Thijs L, et al. Age-specific differences between conventional and ambulatory daytime blood pressure values. Hypertension. 2014;64:1073-9. [PMID: 25185130] doi:10.1161/HYPERTENSIONAHA.114.03957 CrossrefMedlineGoogle Scholar10. Gwadry-Sridhar FH, Manias E, Lal L, et al. Impact of interventions on medication adherence and blood pressure control in patients with essential hypertension: a systematic review by the ISPOR medication adherence and persistence special interest group. Value Health. 2013;16:863-71. [PMID: 23947982] doi:10.1016/j.jval.2013.03.1631 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Assistance Publique-Hôpitaux de Paris and Sorbonne Université, Paris, FranceDisclosures: The author has reported no disclosures of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-3648.Corresponding Author: Olivier Steichen, MD, PhD, Service de médecine interne, hôpital Tenon, 4 rue de la Chine, F-75020 Paris, France; e-mail, olivier.[email protected]fr.This article was published at Annals.org on 5 October 2021. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAdding a New Medication Versus Maximizing Dose to Intensify Hypertension Treatment in Older Adults Carole E. Aubert , Jeremy B. Sussman , Timothy P. Hofer , William C. Cushman , Jin-Kyung Ha , and Lillian Min Metrics December 2021Volume 174, Issue 12Page: 1749-1750KeywordsDrugsHypertension ePublished: 5 October 2021 Issue Published: December 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...