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Effects of a structured treatment algorithm on blood pressure goal rates in both stage 1 and stage 2 hypertension

Journal of Human Hypertension volume 20, pages 255–262 (2006)Cite this article

Abstract

This study analysed the efficacy of an angiotensin receptor blocker-based treatment algorithm for achieving goal blood pressure (BP) in patients with stage 1 (systolic BP (SBP) 140–159 mmHg or diastolic BP (DBP) 90–99 mmHg) or stage 2 (SBP ⩾160 mmHg or DBP ⩾100 mmHg) hypertension. In this 24-week, open-label, multicentre study, patients followed a six-step algorithm until goal BP (⩽130/85 mmHg) was attained. Initially, olmesartan medoxomil 20 mg/day was administered for 4 weeks. The regimen was modified every 4 weeks until goal BP was attained: increase olmesartan medoxomil to 40 mg/day; add hydrochlorothiazide (HCTZ) 12.5 mg/day; increase HCTZ to 25 mg/day; add amlodipine besylate 5 mg/day; increase amlodipine besylate to 10 mg/day. In patients with stage 1 hypertension, 80% (63/79) and 56% (44/79) achieved BP goals of ⩽140/90 mmHg and ⩽130/85 mmHg, respectively, with olmesartan medoxomil monotherapy (94% (74/79) and 89% (70/79) with olmesartan medoxomil/HCTZ double therapy, and 96% (76/79) and 98% (77/79) with addition of amlodipine besylate (triple therapy)). Mean SBP/DBP reductions were 16.7/11.6, 24.8/15.8, and 26.4/16.5 mmHg for mono-, double-, and triple-therapy, respectively. In patients with stage 2 hypertension, 42% (42/100) and 19% (19/100) achieved BP goals of ⩽140/90 mmHg and ⩽130/85 mmHg, respectively, with monotherapy (75% (75/100) and 54% (54/100) with double therapy, and 90% (90/100) and 81% (81/100) with triple-therapy). Mean SBP/DBP reductions in stage 2 patients were 18.4/10.0, 32.7/16.3, and 39.1/19.4 mmHg for mono-, double, and triple therapy, respectively. Overall, most patients with stage 1 or stage 2 hypertension achieved goal BP.

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Acknowledgements

This study was supported by Sankyo Pharma Inc. Joel M Neutel, David HG Smith, and Michael A Weber provide consulting or speaking services for Sankyo, Novartis, Bristol-Myers Squibb, Sanofi, and Merck and have interests in Integrium, a contract research organization that managed the clinical aspects of this study.

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Authors and Affiliations

  1. Orange County Research Center, Tustin, CA, USA

    J M Neutel

  2. Integrium, Tustin, CA, USA

    D H G Smith

  3. Memorial Research Medical Clinic, Long Beach, CA, USA

    D H G Smith

  4. Sankyo Pharma Inc., Parsippany, NJ, USA

    T N Silfani

  5. Forest Research Institute, Jersey City, NJ, USA

    Y Lee

  6. State University of New York Downstate College of Medicine, Brooklyn, NY, USA

    M A Weber

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  1. J M Neutel
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  2. D H G Smith
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  3. T N Silfani
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Correspondence to J M Neutel.

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Neutel, J., Smith, D., Silfani, T. et al. Effects of a structured treatment algorithm on blood pressure goal rates in both stage 1 and stage 2 hypertension. J Hum Hypertens 20, 255–262 (2006). https://doi.org/10.1038/sj.jhh.1001974

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  • DOI: https://doi.org/10.1038/sj.jhh.1001974

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