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Combination antihypertensive therapy in clinical practice. The analysis of 1254 consecutive patients with uncontrolled hypertension

Journal of Human Hypertension volume 30, pages 35–39 (2016)Cite this article

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Abstract

The aim of the study was to analyze the clinical use of different types of combination therapy in a large sample of consecutive patients with uncontrolled hypertension referred to Hypertension Centre. We performed a retrospective analysis of combination antihypertensive therapy in 1254 consecutive patients with uncontrolled hypertension receiving at least triple-combination antihypertensive therapy. Among the most prescribed antihypertensive classes were renin-angiotensin blockers (96.8%), calcium channel blockers (82.5%), diuretics (82.0%), beta-blockers (73.0%), centrally acting drugs (56.0%) and urapidil (24.1%). Least prescribed were spironolactone (22.2%) and alpha-1-blockers (17.1%). Thiazide/thiazide-like diuretics were underdosed in more than two-thirds of patients. Furosemide was prescribed in 14.3% of patients treated with diuretics, while only indicated in 3.9%. Inappropriate combination therapy was found in 40.4% of patients. Controversial dual and higher blockade of renin-angiotensin system occurred in 25.2%. Incorrect use of a combination of two antihypertensive drugs with the similar mechanism of action was found in 28.1%, most commonly a combination of two drugs with central mechanism (13.5%). In conclusion, use of controversial or incorrect combinations of drugs in uncontrolled hypertension is common. Diuretics are frequently underdosed and spironolactone remains neglected in general practice. The improper combination of antihypertensive drugs may contribute to uncontrolled hypertension.

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Acknowledgements

We thank all physicians who recommended patients to our Hypertension Center. This study was supported by the Czech Ministry of Health (NT14155-3/2013 and NT13046-4/2012) and by research programs of Charles University (PRVOUK P35/LF1/5 and P25/LF1/2).

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Authors and Affiliations

  1. 3rd Department of Medicine–Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University in Prague, General University Hospital in Prague, Prague, Czech Republic

    O Petrák, T Zelinka, B Štrauch, J Rosa, Z Šomlóová, T Indra, H Turková, R Holaj & J Widimský Jr

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  1. O Petrák
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  2. T Zelinka
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  3. B Štrauch
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  5. Z Šomlóová
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Correspondence to O Petrák.

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Petrák, O., Zelinka, T., Štrauch, B. et al. Combination antihypertensive therapy in clinical practice. The analysis of 1254 consecutive patients with uncontrolled hypertension. J Hum Hypertens 30, 35–39 (2016). https://doi.org/10.1038/jhh.2015.24

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