¹Department of Cardiovascular Disease, Clinical Investigation Center INSERM CHU, University Henri Poincaré, Nancy, France

Correspondence: Professor F Zannad, Department of Cardiovascular Disease, Clinical Investigation Center INSERM CHU, University Henri Poincaré, Nancy, France. E-mail: f.zannad@chu-nancy.fr

Abstract

Current international guidelines recommend the use of therapeutic strategies with proven efficacy in the management of hypertension to achieve a target blood pressure of <140/90 mmHg. After lifestyle intervention, they endorse three different management strategies: (i) first-line use of a low-dose combination of two agents from different antihypertensive classes, with the option of doubling the dose of the combination; (ii) use of a sequential monotherapy strategy, initiating with one antihypertensive to be replaced by another one from a different class, if necessary; and (iii) a stepped care strategy, initiating with one antihypertensive, and increasing the dose or adding another agent from a different class, if necessary. The objective of the STRAtegies of Treatment in Hypertension: Evaluation (STRATHE) study was to compare the efficacy and tolerability of these three treatment strategies in patients with uncomplicated essential hypertension (n=533). In all, 62% of the patients in the low-dose combination group were normalised (<140/90 mmHg), compared with 49% of the sequential monotherapy group (P=0.01) and 47% of the stepped-care group (P=0.005). The percentage of patients achieving normalisation without experiencing drug-related adverse events was also significantly higher in the low-dose combination group (56%) than in the sequential monotherapy (42%, P=0.001) and stepped-care groups (42%, P=0.004), consistent with the observation that the reduced dosage of the antihypertensive agents in such preparations translates into improved acceptability. The results of STRATHE provide further support for an antihypertensive management strategy involving the low-dose combination of perindopril (2 mg) and indapamide (0.625 mg).