Imperial College London
Alternate

Professor Neil Poulter

Faculty of Medicine, School of Public Health

Professor of Preventive Cardiovascular Medicine.
 
 
 
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Contact

 

+44 (0)20 7594 3446n.poulter

 
 
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Assistant

 

Mrs Ranjit Rayat +44 (0)20 7594 3445

 
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Location

 

55Stadium HouseWhite City Campus

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Summary

 

Publications

Citation

BibTex format

@article{Marinier:2019:10.1002/pds.4884,
author = {Marinier, K and Macouillard, P and de, Champvallins M and Deltour, N and Poulter, N and Mancia, G},
doi = {10.1002/pds.4884},
journal = {Pharmacoepidemiology and Drug Safety},
pages = {1572--1582},
title = {Effectiveness of two-drug therapy versus monotherapy as initial regimen in hypertension: A propensity score-matched cohort study in the UK Clinical Practice Research Datalink},
url = {http://dx.doi.org/10.1002/pds.4884},
volume = {28},
year = {2019}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - PURPOSE: To compare the effectiveness on blood pressure (BP) of initial two-drug therapy versus monotherapy in hypertensive patients. METHODS: Using the Clinical Practice Research Datalink, linked with Hospital Episode Statistics and Office for National Statistics, we identified a cohort of adults with uncontrolled hypertension, initiating one or two antihypertensive drug classes between 2006 and 2014. New users of two drugs and monotherapy were matched 1:2 by propensity score. Main exposure was "as-treated," ie, until first regimen change. Primary and secondary endpoints were systolic and diastolic BP control and major adverse cardiovascular event (MACE), respectively. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox proportional hazard models. RESULTS: Of 54 523 eligible patients, 3256 (6.0%) were initiated to a two-drug combination. Of these, 2807 were matched to 5614 monotherapy users. Mean exposure duration was 12.7 months, with 76.5% patients changing their initial regimen. Two-drug therapy was associated with a clinically significant BP control increase in all hypertensive patients (HR = 1.17 [95%CI: 1.09-1.26]), more so in patients with grade 2-3 hypertension (HR = 1.28 [1.17-1.41]). An increase of 27% in BP control (HR = 1.27 [1.08-1.49]) was observed in patients initiating an ACEi+CCB combination compared with initiators of either single class. No significant association was found between two-drug therapy and MACE. Several sensitivity analyses confirmed the main findings. CONCLUSIONS: Few patients initiated therapy with two drugs, reflecting UK guidelines' recommendation to start with monotherapy. This study supports the greater effectiveness of two-drug therapy as the initial regimen for BP control.
AU  - Marinier,K
AU  - Macouillard,P
AU  - de,Champvallins M
AU  - Deltour,N
AU  - Poulter,N
AU  - Mancia,G
DO  - 10.1002/pds.4884
EP  - 1582
PY  - 2019///
SN  - 1053-8569
SP  - 1572
TI  - Effectiveness of two-drug therapy versus monotherapy as initial regimen in hypertension: A propensity score-matched cohort study in the UK Clinical Practice Research Datalink
T2  - Pharmacoepidemiology and Drug Safety
UR  - http://dx.doi.org/10.1002/pds.4884
UR  - https://www.ncbi.nlm.nih.gov/pubmed/31482621
UR  - http://hdl.handle.net/10044/1/84187
VL  - 28
ER  -
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