A recent study has revealed that combination treatment with three or more hypertensive medicines provides greater blood pressure lowering effect than monotherapy. Although, the net benefit may be lessened when considering side effects.
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Researchers investigated electronic databases for BP-lowering
randomized controlled trials (RCTs) comparing combination treatment or
monotherapy with placebo, no treatment, or less-complex treatment.
The combination treatment was considered when background
treatment continued during follow-up on top of the trial medicines of interest
and medicines were added to the initial drugs of interest in most patients.
Monotherapy, on the other hand, was considered when pre-randomization treatment
was withdrawn or absent and a single drug was administered at random.
Notably, complexity of treatment refers to the higher
averaged number of daily medications used in the eligible RCTs.
There were 93 trials including 290,304 patients with
follow-up period of 3.9 years were included in the analysis. On-treatment
average number of drugs was 2.10 in the more actively treated patients and 0.99
in the less actively treated group.
The combination treatments of any complexity compared
with placebo, no treatment, or less-complex treatment resulted in a reduction
of all or most fatal and non-fatal outcomes.
On the other hand, there was an increased rate of side
effects that led to treatment discontinuation was observed during the study,
but in absolute numbers the benefit outweighed the harm.
Researchers said that use of drug combinations is recommended
by hypertension guidelines for most patients because of the greater BP-lowering
effect compared with monotherapy.
Source: J Hypertension 2021