NEW YORK (Reuters Health) – For the management uncomplicated hypertension, using initial low-dose, fixed-dose combination therapy is better than guideline-based treatment, according to a report in the April issue of Hypertension.

“Notwithstanding the availability of antihypertensive drugs and practice guidelines, blood pressure control remains suboptimal. The complexity of current treatment guidelines may contribute to this problem,” lead author Dr. Ross D. Feldman, from Robarts Research Institute, London, Ontario, Canada, and colleagues note.

In the STITCH (Simplified Treatment Intervention to Control Hypertension) study, the researchers assessed the outcomes of patients who were treated at 45 family practices that were randomized to manage hypertension with the STITCH approach or based on Canadian Hypertension Education Program (CHEP) guidelines.

With STITCH, treatment began with a low-dose ACE inhibitor or angiotensin receptor blocker combined with a diuretic. This treatment was then increased as needed to achieve blood pressure control. A calcium blocker could then be added and increased in dose if needed. As a last step, a non-first-line agent could be given if necessary.

At 6 months, 64.7% of STITCH patients achieved their target blood pressure, defined as <140/90 mmHg in non-diabetics or <130/80 mmHg in diabetics. The percentage in the control group was significantly lower, 52.7% (p = 0.026). On multivariate analysis, use of the STITCH approach increased the odds of reaching the target blood pressure by 20% (p = 0.028). In a related editorial, Dr. Brent M. Egan, from the Medical University of South Carolina, Charleston, comments that the study “suggests that further practical clinical trials using fixed-dosed combinations and simplified treatment algorithm are needed and justified to explore this promising lead.” He adds that “in an ever increasingly complex world, the old adage, ‘keep it simple (stupid),’ may just be one of the keys to better cardiovascular health in the years ahead.” Reference:
Hypertension 2009;53:598-599,646-653.