EFFECTIVENESS OF ANTIHYPERTENSIVE THERAPY DOUBLE AND TRIPLE COMBINATION IN PATIENTS WITH ARTERIAL HYPERTENSION ON PRIMARY CARE

Objective: Purpose: to evaluate the effectiveness of antihypertensive therapy with generic forms of free combinations ramipril or telmisartan with amlodipine and hydrochlorothiazide, in patients with hypertension at the primary medical care. Design and method: The study included 1200 patients with office blood pressure (BP) more than 140/90 mmHg without obesity and DM. All patients had three visits: inclusion (assessment of history, BP, heart rate, biochemical blood tests, antihypertensive therapy prescription), titration visit (BP, heart rate, assessment of adherence to therapy, side effects, biochemical blood tests), completion visit (assessment of BP, heart rate, adherence to therapy (questionnaire), side effects, results of biochemical blood tests, selection of further therapy). Results: At the first visit, all patients were prescribed monotherapy ramipril, while the choice of the second drug in the combination was left to the doctor’s discretion. A combination of ramipril/hydrochlorothiazide was prescribed to 35% of patients, and the other 65% started taking a combination of ramipril/amlodipine. After 1 month of treatment, systolic BP decreased by 20 mmHg in the ramipril/amlodipine group and by 18 mmHg in the ramipril/hydrochlorothiazide group. At the second visit, it was allowed to switch a patient to telmisartan if necessary, and to add the third component of a combination. In general, among all study participants, about 9% were switched to a telmisartan-based combination. In the general group, a triple combination (ramipril or telmisartan + amlodipine + hydrochlorothiazide) was prescribed to 32% of patients in order to achieve effective blood pressure control, while 68% continued to take a double combination. After 3 months, there was a significant reduction in office BP in both groups (office BP decreased by 27/13 and 32/15 mmHg in the double versus triple therapy). Drug adherence remained high in both groups. Conclusions: 32% patients needed triple combination and 68% had need double combination. The use of free double or triple combination of ramipril or telmisartan with amlodipine and hydrochlorothiazide, was effectiveness and good tolerability, adherence in patients with hypertension at the primary medical care.