Table 1.
Treatment Intensification Regimens
| Intensification Treatment |
||||||||
|---|---|---|---|---|---|---|---|---|
| Baseline Treatment | Step 1 | Step 2 | Step 3 | Step 4 | Step 5 | Step 6 | Step 7 | Step 8 |
| LDL | ||||||||
| None | Add SMV20 | Intensify to SMV40 | Switch to ATV40 | Intensify to ATV80 | Switch to SMV/EZE | — | — | — |
| Nonstatin | Add SMV20 | Intensify to SMV40 | Switch to ATV40 | Intensify to ATV80 | Switch to SMV/EZE | — | — | — |
| Low-dose statin | Intensify to SMV40 | Switch to ATV40 | Intensify to ATV80 | Switch to SMV/EZE | — | — | — | — |
| A1c | ||||||||
| None | Add MET | Add SUL | Add TZD | Add INS | — | — | — | — |
| Sulfonylurea (SUL) | Intensify SUL | Add MET | Add TZD | Add INS | — | — | — | — |
| Insulin (INS) | Add MET | Add TZD | Intensify INS | — | — | — | — | — |
| Sulfonylurea+insulin | Add MET | Add TZD | Intensify INS | — | — | — | — | — |
| BP | ||||||||
| None | Add THI | Add ACE | Add BBL | Add CCB | Intensify THI | Intensify ACE | Intensify BBL | Intensify CCB |
| Thiazide (THI) | Add ACE | Add BBL | Add CCB | Intensify THI | Intensify ACE | Intensify BBL | Intensify CCB | — |
| ACE Inhibitor (ACE) | Add THI | Add BBL | Add CCB | Intensify THI | Intensify ACE | Intensify BBL | Intensify CCB | — |
| Beta blocker (BBL) | Add THI | Add ACE | Add CCB | Intensify THI | Intensify ACE | Intensify BBL | Intensify CCB | — |
| Calcium channel blocker (CCB) | Add THI | Add ACE | Add BBL | Intensify THI | Intensify ACE | Intensify BBL | Intensify CCB | — |
Notes. Metformin therapy was considered contraindicated for subjects having a standardized creatinine level exceeding 150 μmol/L or a diagnosis of congestive heart failure (12.8% of the population) (Jones, Macklin, and Alexander 2003).
Patients who reported taking insulin without concomitant sulfonylurea were assumed to have had a history of prior treatment with sulfonylurea and then discontinued. For patients treated with multiple antihypertensive classes at baseline, drugs were added in the following order as needed: THI, ACE, BBL, and CCB.ATV, Atorvastatin; MET, Metformin; SMV/EZE, Simvastatin 80 mg/Ezetimibe 10 mg; SMV20, Simvastatin 20 mg; TZD, Thiazolidinedione.