2009;122:290–300. Figure 3 A, B, Number needed-to-treat (A) and the relative risk of clinical worsening (B) at predefined time points using the Kaplan-Meier method and data from long-term event driven trials comparing combination therapy vs monotherapy in pulmonary arterial hypertension. However, combination therapy is a beneficial alternative. A study on comparison of monotherapy versus combination therapy for hypertensive patients at tertiary care hospital The study, “ Monotherapy in patients with pulmonary arterial hypertension at four German PH centres, ” was published in the journal BMC Pulmonary Medicine. Similar results were observed with other trial of olmesartan medoxomil/amlodipine combination therapy vs. respective monotherapies where more effective BP reduction and BP goals (44.5-54% vs 28.5-30%) were achieved with combination therapy than with either of monotherapies. The results showed a clear improvement in efficacy with … Neither monotherapy nor combination therapy affected (b) SNP-induced vasorelaxation. In this multi-center, double-blind, randomized study, adult patients (n = 148) with stage 2 hypertension were randomized to amlodipine 5 mg/losartan 50 mg or amlodipine … Background Monotherapy with endotelin antagonist receptors (ERA) an phosphodiesterase 5 (PDE5) inhibitors is a first choice treatment for PAH in functional class (FC) II-III, with the same grade of evidence and recommendation than combination therapy. The researchers found no significant difference (P = .411) in survival among patients prescribed monotherapy vs combination therapy. Several randomized clinical trials have proven the efficacy of combination therapy to be superior to monotherapy as initial treatment for timely and adequate BP control. ... Monotherapy versus Polytherapy in Patients with Hypertension H Combination Therapy Versus Monotherapy in Reducing Blood Pressure: Meta-analysis on 11,000 Participants from 42 trials Problem: A 68yo male VA patient who is on 12.5mg Hydrochlorothiazide with uncontrolled hypertension.Which is more advantageous to the patient – increase HCTZ to 25mg or to add anther agent? However, other recent results have shown beneficial effects of combination therapy versus monotherapy alone. 86. Moreover, a retrospective analysis comparing combination antihypertensive therapy regimens vs monotherapy showed that patients who initially started on combination therapy were more likely to achieve BP goals after 12 months of therapy compared with patients who had started on monotherapy. 15 Despite starting with higher untreated BP, patients who began treatment with single-pill combinations were more likely to achieve BP control than those started on free combinations or monotherapy … Combination therapy is proved to be more effective in reducing morbidity and mortality. Hypertensive patients initiated on single-pill combinations had higher untreated BP values and were more likely to have stage 2 hypertension than those started on monotherapy, which is consistent with clinical guidelines for initial therapy in patients ≥20/≥10 mm Hg from goal. A doctor prescribing medicines to reduce the blood pressure for the first time in a patient has two options: using only one medicine (monotherapy) or using two medicines (combination therapy). The current experience with combination therapy in chronic thromboembolic pulmonary hypertension (CTEPH) is limited. The objective of this trial was to compare the blood-pressure lowering efficacy of amlodipine/losartan combination with amlodipine monotherapy after 6 weeks of treatment in Korean patients with stage 2 hypertension. While early combination treatments are the standard option in PAH, they are not suitable for older patients with atypical PAH. Although combination therapy is the gold standard for patients with pulmonary arterial hypertension (PAH), some of these patients are still being treated with monotherapy. Combination therapy versus monotherapy in reducing blood pressure: meta-analysis on 11,000 participants from 42 trials. Advantages and disadvantages of treatment of hypertension with low dose combination therapy versus monotherapy Monotherapy Combination therapy extemporaneous fixed Monotherapy with either Aml or AT partially improved EDR to acetylcholine. Initial monotherapy and combination therapy and hypertension control the first year. The 12-week PATENT-1 study showed that riociguat improved 6MWD compared to placebo in patients receiving riociguat in addition to endothelin receptor antagonists or prostanoids . High-dose monotherapy vs low-dose combination therapy of calcium channel blockers and angiotensin receptor blockers in mild to moderate hypertension. Meta-Analysis of Monotherapy Versus Combination Therapy for Pulmonary Arterial Hypertension Benjamin D. Fox, BM, BSa,b, Avi Shimony, MDa,c, and David Langleben, MDa,* Previous studies comparing combination therapy (CT) of pulmonary vasodilators to mono-therapy (MT) in patients with pulmonary arterial hypertension (PAH) report conflicting eMediNexus, 09 July 2021 Coronavirus Live Count Map India remove_red_eye 4087 Views COVID-19 Vaccine Updates Coronavirus Protocols. The numbers of included participants and, hence the number of events, were too small to draw any conclusion about the relative efficacy of monotherapy versus combination therapy as initial treatment for primary hypertension. Tel: +302106402262; e-mail: thokos@otenet.gr. To Compare the Efficacy of Combination Therapy vs Monotherapy for Pulmonary Arterial Hypertension in Systemic Sclerosis (BosSilSS) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. This meta-analysis of seven randomized, double-blind studies (N = 5888) evaluated 8 weeks of olmesartan medoxomil (OM)-based single-pill dual-combination therapy (OM+amlodipine/azelnidipine or hydrochlorothiazide) vs OM monotherapy in adults with hypertension. Am J Med 2009; 122:290-300. In such patients, initial combination therapy using two drugs is recommended [ 50 ]. First-line combination therapy versus first-line monotherapy for primary hypertension. However, both agents may be used in patients with certain comorbid conditions or in combination therapy. 2012;59:1124-31. Hypertension is a complex, multisystem disorder in which numerous interrelated factors contribute to elevated blood pressure (BP). Introduction Previous studies have suggested that more intensive initial therapy for hypertension results in better long-term blood pressure (BP) control. Clin Ther . Combination therapy may be superior or, at least, as equally effective as mono-therapy in the prevention of organ damage associated with hypertension. This meta‐analysis of seven randomized, double‐blind studies (N = 5888) evaluated 8 weeks of olmesartan medoxomil (OM)–based single‐pill dual‐combination therapy (OM+amlodipine/azelnidipine or hydrochlorothiazide) vs OM monotherapy in adults with hypertension. Detailed Description: To determine if patients randomised to more aggressive (combination therapy) treatment for the initial treatment of hypertension have better blood pressure control compared to those randomised to less aggressive (monotherapy) treatment despite subsequent add-on treatment being similar in each group. Methods All patients with SSc-associated PAH from the Spanish Scleroderma Registry … The SBP treatment goal is a pressure level of < 140 mm Hg (Grade C). Following initial monotherapy, home systolic BP decreased by 4.9 mm Hg (range: –6.0 to 3.7 mm Hg) less than after initial combination therapy during a 32-week period (P <.001).The differences, however, became similar at 32 weeks (difference: 1.2 mm Hg [range:–0.4 to 2.8 mm Hg]; P =.13). The use of metformin or troglitazone in combination with insulin has also demonstrated improved blood glucose control over insulin therapy alone ( 31 – 34 ). ecent hypertension guidelines have placed increased emphasis on initial use of combination therapy for most individuals [1,2], in contrast to previous ones that traditionally recommended stepped-care strategy with initial monotherapy [3,4]. 1 and 2 in the combination versus monotherapy arms. Imidapril and indapamide showed similar efficacy compared with eprosartan monotherapy but not with amlodipine monotherapy. Single nucleotide polymorphism (SNP)–induced vasorelaxation was not impaired in hypertensive DS rats. Combination therapy was also associated with improved functional status in patients. It also focuses on to compare the efficacy and compliance of fixed-dose combination (FDC) as compared to monotherapy and conventional multi-pill combination therapy as the initial treatment of hypertension. In such cases, the rate of side effects is generally higher and the combo therapy less effective. All drug classes demonstrated increases in 6MWD when compared with placebo, and combination therapy showed improved 6MWD compared with monotherapy. We systematically searched the Cochrane Library, EMBASE, and MEDLINE databases for randomized controlled trials comparing CT to MT for patients with PAH. Meta-Analysis of Monotherapy Versus Combination Therapy for Pulmonary Arterial Hypertension. Monotherapy is an option as first-line therapy for pulmonary arterial hypertension (PAH). However, other recent results have shown beneficial effects of combination therapy versus monotherapy alone. 2017;6:e007131. Primary endpoint was sitting DBP at trough. Monotherapy is a type of treatment which uses a single agent drug acting in a particular way for treatment. Am J Cardiol 2011;108:1177–1182 Combination Therapy did not decrease the combined end point of mortality, admission for worsening PAH, lung transplantation, or escalation of PAH therapy (RR 0.42, 95% CI 0.17 to 1.04). Where to Look: The American Journal of Medicine 2009, 122 (3), pp.290-300 23 In light of these findings, initiating antihypertensive treatment with combination therapy … There were no differences in withdrawals due to adverse events. Initial combination therapy can be recommended for patients with BP >150/95 mm Hg. URL: http://www.ClinicalTrials.gov. Unique identifier: NCT 00994617. What Is New? Monotherapy vs combination treatments of different complexity: a meta-analysis of blood pressure lowering randomized outcome trials. If combination is superior in this analysis, then the averaged mean HSBP between initial monotherapy and initial combination therapy at the end of phase 2 will be compared. Combination Therapy Is Superior to Sequential Mono- therapy for the Initial Treatment of Hypertension 13. A greater drop in systolic and in diastolic blood pressure was obtained by combination of amlodipine and indapamide compared with amlodipine or eprosartan monotherapy. Our objective was to evaluate the efficacy of monotherapy versus combination therapy in patients with … BACKGROUND Starting with one drug and starting with a combination of two drugs are strategies suggested in clinical guidelines as initial treatment of hypertension. The actual harm-to-benefit balance of each strategy is unknown. Similar results were observed with other trial of olmesartan medoxomil/amlodipine combination therapy vs. respective monotherapies where more effective BP reduction and BP goals (44.5-54% vs 28.5-30%) were achieved with combination therapy than with either of monotherapies. At the same time, ARBs and CCBs can both be used in conjunction with each other as a part of combination therapy for treatment of Hypertension where monotherapy fails to show desired results. Using a single pill may enhance compliance and simplify treatment, which would translate into better clinical outcomes. Modern tactics of treatment of arterial hypertension (AH) involves the use of both monotherapy and combination therapy. • Initial treatment can make use of monotherapy or combination of two drugs at low doses with a subsequent increase in drug doses or number, if AU - Hilleman, D. E. AU - Ryschon, K. L. AU - Mohiuddin, S. M. AU - Wurdeman, Richard L. N1 - Funding Information: This study was supported in part by an unrestricted educational grant from Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA. Combination Therapy vs. Monotherapy. Monotherapy is a type of treatment which uses a single agent drug acting in a particular way for treatment. 2007 ESH-ESC Hypertension Guidelines: MONOTHERAPY VERSUS COMBINATION THERAPY • Regardless of the drug employed, monotherapy allows to achieve BP target in only a limited number of hypertensive patients. Our objective was to evaluate the efficacy of monotherapy versus combination therapy in patients with … Mean reduction in proteinuria with combination vs ARB monotherapy in 5- to 12-month studies was 0.75 vs 0.82 (ratio of means) with ACE inhibitors. The researchers found no significant difference (P = .411) in survival among patients prescribed monotherapy vs combination therapy. Several recent guidelines advocate for initial combination drug therapy in many patients. Abstract. Initial monotherapy is successful in many patients with mild primary hypertension. T1 - Fixed-dose combination vs monotherapy in hypertension. Combination therapy versus monotherapy for pulmonary arterial hypertension: a meta-analysis Annie Christine Lajoie*, Gabriel Lauzière*, Jean-Christophe Lega, Yves Lacasse, Sylvie Martin, Serge Simard, Sebastien Bonnet†, Steeve Provencher† Summary We identified 131 incident PAH patients, with a mean age of 64 ± 13.8 … Combination therapy can be in the same tablet or in different tablets. C. Goals of therapy for adults with hypertension without compelling indications for specific agents Recommendations. Compared with standard-dose monotherapy, initiating treatment with low-to-standard dose dual combination therapy is more efficacious without increasing withdrawals due to adverse events. Although most hyper- Combination (comb) therapy normalized EDR to acetylcholine. Hypertension Update: Amlodipine and Atenolol: Combination Therapy Versus Monotherapy for blood pressure Management . There was insuffi cient statistical power to detect a mortality difference associated with treatment. These properties are difficult to achieve with monotherapy; therefore, low doses of complementary drugs have been combined in an attempt to create a treatment for hypertension that is closer to the ideal. Meta-Analysis of Monotherapy Versus Combination Therapy for Pulmonary Arterial Hypertension Benjamin D. Fox, et al. Rubio-Guerra AF, Castro-Serna D, Elizalde-Barrera CI, Ramos-Brizuela LM. Combination therapy using sulfonylurea agents and metformin and/or troglitazone has been shown to improve blood glucose control compared with monotherapy (27–30). Therefore, early combination therapy is better than sequential monotherapy. Some antihypertensive combinations have been shown to be harmful. Keywords: Hypertension, Mono therapy, poly treatment. Properties of the ideal antihypertensive agent are given in Fig. Median survival was 9 months for sildenafil monotherapy and 10 months for combination therapy (p = 0.49). [9,10] Results of the trial showed that despite a reduction in systolic blood pressure of 2-3 mm Hg in the combination therapy group as compared … Combination Therapy vs. Monotherapy. However, single-drug therapy is unlikely to attain goal blood pressure in patients whose blood pressures are more than 20/10 mmHg above goal. The objective of this meta-analysis is to compare the effects of … Because therapy with a single agent usually targets a single mechanism of action, higher doses of medications are often required to lower BP sufficiently, with the concomitant risk of dose-dependent adverse effects that may affect patient compliance with … We test this hypothesis comparing initial monotherapy with dual therapy in the management of essential hypertension. Because therapy with a single agent usually targets a single mechanism of action, higher doses of medications are often required to lower BP sufficiently, with the concomitant risk of dose-dependent adverse effects that may affect patient compliance with … Over 70% of patients on combination therapy achieved BP goals . Background In a free drug combination, each Blood pressure (BP)-lowering drug is administered as a separate pill, while in a fixed drug combination several BP-lowering agents are combined in a single pill. Correspondence to Costas Thomopoulos, MD, Department of Cardiology, Helena Venizelou Hospital, 2, Helena Venizelou sqr., 11521 Athens, Greece. Study Design: Pooled results from two U.S. phase III, 3-month, multicenter, randomized, double-blind, parallel-group, placebo-controlled studies of BYSTOLIC monotherapy for the treatment of mild to moderate hypertension. The recommendations are not based on evidence about clinically relevant outcomes. Objective Monotherapy is an option as first line therapy for pulmonary arterial hypertension (PAH). 3.1. Clinical trials in PAH. Several recent guidelines advocate for initial combination drug therapy in many patients. Over 70% of patients on combination therapy achieved BP goals . open-angle glaucoma or ocular hypertension partici-pated in a 6-month, randomized, double-masked, mul-ticenter study with 3 parallel treatment groups. Background: Although combination therapy is the gold standard for patients with pulmonary arterial hypertension (PAH), some of these patients are still being treated with monotherapy. Figure 1 shows the time-course of the 41 RCTs performed in 9061 PAH patients and published so far [30–70]. Initial antihypertensive therapy with single-pill combinations produced more rapid blood pressure control than initial monotherapy in clinical trials. Other studies reported better cardiovascular outcomes in patients achieving lower blood pressure during the first treatment year. amlodipine/valsartan combination of either 5/160 or 10/160 mg,9) or they compared monotherapy with combination in various dosages as an initial treatment in stage 2 hypertension.10) Meta-analysis showed that combination therapy in general had much greater BP-lowering efficacy than did doubling the monotherapy dose.11) Globally, combination therapy resulted in a 35% reduction of clinical worsening compared with monotherapy. INTRODUCTION ypertension is a prevalent cardiovascular disease which is a major reason for mortality and morbidity. The question before a practitioner then becomes, whether to use a higher dose of one class of drug or to go for a combination therapy. T2 - A meta-analysis evaluation. Fixed-dose combination antihypertensive therapy has received interest since the publication of the JNC-VI report. Relatively few head-to-head comparative studies between fixed-dose combinations and first-line monotherapies for hypertension have been published. A systematic review of dual combination vs. monotherapy as initial therapy in hypertension is reported for this application, including 33 trials with more than 10,000 participants in total. Monotherapy with ACE inhibitors or ARBs reduced proteinuria to a similar degree but less than combination therapy. Hypertension. The Candesartan and Diuretic versus Amlodipine in hypertensive patients (CANDIA) trial evaluated candesartan+HCTZ combination versus amlodipine monotherapy.39 This multicentre, double-blinded, randomised trial assessed patients with mild-to-moderate HTN not adequately controlled with monotherapy. : amlodipine and Atenolol: combination therapy was also associated with treatment single pill may enhance compliance and simplify,... The JNC-VI report to MT for patients with BP > 150/95 mm Hg ( Grade ). 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