Monotherapy in Early Control of Blood Pressure

Starting antihypertensive therapy with a two-drug combination works better than initial monotherapy, according to a Lancet study. (A drug manufacturer participated in the trial’s design and execution.)

Researchers in the ACCELERATE trial randomized some 1200 adult hypertensives either to 4 months of initial combination therapy with aliskiren plus amlopidine, or to either drug alone as monotherapy. At the 4-month mark, all patients were placed on the combination regimen.

By 4 months, mean systolic blood pressure reductions favored the combination group by some 6.5 mm Hg, but by 6 months, the difference was no longer significant. The authors point out, though, that “once the monotherapy patients progressed to combination therapy, their blood pressure fell towards, but never numerically caught up with, that of the initial combination group.”

Commentators conclude that “a change in guidelines [for initial therapy] is clearly necessary.”

(Fuente: Lancet)