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Application in the STRATHE trial of a score system to compare the efficacy and the tolerability of different therapeutic strategies in the management of hypertension

By Bernard Waeber and Jean-Jacques Mourad


A score system integrating the evolution of efficacy and tolerability over time was applied to a subpopulation of the STRATHE trial, a trial performed according to a parallel group design, with a double-blind, random allocation to either a fixed-dose combination strategy (perindopril/indapamide 2 mg/0.625 mg, with the possibility to increase the dose to 3 mg/0.935 mg, and 4 mg/1.250 mg if needed, n = 118), a sequential monotherapy approach (atenolol 50 mg, followed by losartan 50 mg and amlodipine 5 mg if needed, n = 108), or a stepped-care strategy (valsartan 40 mg, followed by valsartan 80 mg and valsartan 80 mg+ hydrochlorothiazide 12.5 mg if needed, n = 103). The aim was to lower blood pressure below 140/90 mmHg within a 9-month period. The treatment could be adjusted after 3 and 6 months. Only patients in whom the study protocol was strictly applied were included in this analysis. At completion of the trial the total score averaged 13.1 ± 70.5 (mean ± SD) using the fixed-dose combination strategy, compared with −7.2 ± 81.0 using the sequential monotherapy approach and −17.5 ± 76.4 using the stepped-care strategy. In conclusion, the use of a score system allows the comparison of antihypertensive therapeutic strategies, taking into account at the same time efficacy and tolerability. In the STRATHE trial the best results were observed with the fixed-dose combination containing low doses of an angiotensin enzyme converting inhibitor (perindopril) and a diuretic (indapamide)

Topics: Original Research
Publisher: Dove Medical Press
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Provided by: PubMed Central
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    1. (2001). Adverse events, compliance, and changes in therapy. Current Hypertens Rep,
    2. (2003). Cardiovascular prevention and blood pressure reduction: a quantitative overview updated until 1
    3. (2001). Clinical benefi t of very-low-dose perindopril-indapamide combination in hypertension.
    4. (2004). Comparison of different therapeutic strategies in hypertension: a low-dose combination of perindopril/indapamide versus a sequential monotherapy or a stepped-care approach.
    5. (2004). Drug treatment of essential hypertension: the case for initial combination therapy.
    6. (2005). Effects of different blood pressurelowering regimens on major cardiovascular events in individuals with and without diabetes mellitus: results of prospectively designed overviews of randomized trials.
    7. (2005). Evidence-based medicine in hypertension: what type of evidence?
    8. (2007). Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).
    9. (2002). Is fi xed combination therapy appropriate for initial hypertension treatment? Current Hypertens Rep,
    10. (2004). Outcomes in hypertensive patients at high cardiovascular risk treated with regimens based on valsartan or amlodipine: the VALUE randomised trial.
    11. (2006). Overcoming barriers to effective blood pressure control in patients with hypertension.
    12. (2005). Rate and determinants of 10-year persistence with antihypertensive drugs.
    13. (2005). Recent hypertension trials: implications and controversies.
    14. (2001). Some economic consequences of noncompliance. Current Hypertens Rep,
    15. (1998). The direct costs to the NHS of discontinuing and switching prescriptions for hypertension.
    16. (1990). Treating the individual hypertensive patient: considerations on dose, sequential monotherapy and drug combinations.
    17. (2003). Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials.

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