Skip to main content
NCBI home page
Atencion Primaria logoLink to Atencion Primaria
. 2013 Apr 5;31(3):163–169. [Article in Spanish] doi: 10.1016/S0212-6567(03)70677-5

Efectividad de la terapia combinada a dosis fijas en una cohorte de hipertensos no controlados con monoterapia

Effectiveness of combined therapy at set doses in a cohort of hypertense patients not controlled by single therapy

O Vegazo García a,*, JL Llisterri Caro b, FJ Jiménez Jiménez a, J Aznar Vicente c, J Vicente Lozano d, R Estiarte Navarro a
PMCID: PMC7684243  PMID: 12622983

Abstract

Objective

To evaluate the effectiveness of the fixed dose of a lisinoprilhydrochlorothiazide combination treatment in the control of blood pressure, in poorly controlled high blood pressure people, treated with monotherapy.

Design

Prospective observational study.

Setting

Primary care frame.

Participants

931 patients (56.7% women) with an average age of 62.0±10.3 years, were included by 199 primary care physicians. 915 patients (98%) ended the study and finally they were included for the statistical analysis.

Main measurements

OMS/SIH recommendations on blood pressure measurement and diagnose of poor control were followed. Pulse pressure, body mass index and basic clinical analyses were assessed. Four continuation visits were made during six months.

Results

Lisinopril–hidrochlorothiazide (20/12.5 mg) reduced significantly SBP (24.6±3.5 mm Hg) and DBP (14,3±0.7 mm Hg) (P<.001). Blood pressure control was only influenced by age (OR, 0.81; 95% CI, 0.71-0.92; P=.001). Pulse pressure was reduced in 10.4±4.3 mm Hg (P<.001). After 24 weeks of treatment, glycemic and lipidic profiles showed an improvement, as well as HbA1c in diabetic people.

Conclusions

In Primary care, a 52.8% of poorly controlled with monotherapy high blood pressure people were controlled by a combination of lisinoprilhydrochlorothiazide (20/12.5 mg). In addition, pulse pressure was decreased and both lipid and glucose blood profiles improved.

Key words: Hypertension, Combination therapy, Lisinopril, Primary health care, Spain

Bibliografía

  • 1.Banegas J.R., Rodríguez-Artalejo F., De la Cruz J.J., De Andrés B., Rey J. Mortalidad relacionada con la hipertensión y la presión arterial en España. Med Clin (Barc) 1999;112:489–494. [PubMed] [Google Scholar]
  • 2.Coca Payeras A. Evolución del control de la hipertensión arterial en España Resultados del Estudio Controlpres 98. Hipertensión. 1998;8:20–37. [Google Scholar]
  • 3.Hyman D.J., Pavlik V.N. Characteristic of patients uncontrolled Hypertension in the United States. N Eng J Med. 2001;345:479–486. doi: 10.1056/NEJMoa010273. [DOI] [PubMed] [Google Scholar]
  • 4.Liga Española para la lucha contra la Hipertensión Arterial. Situación actual de la detección, tratamiento y control de la hipertensión arterial en España. Madrid: LELHA, 1995.
  • 5.Hansson L. Presión arterial mal controlada: ¿podemos ofrecer a nuestros pacientes un mejor pronóstico? Med Clin (Barc) 2000;1(Supl 1):12–14. [Google Scholar]
  • 6.Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. The sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and treatment of high blood pressure. Arch Intern Med 1997;157:2413-46. [DOI] [PubMed]
  • 7.World Health Organization, International Society of Hypertension 1999 WHO-ISH Guidelines for the management of hypertension. J Hypertens. 1999;17:151–183. [PubMed] [Google Scholar]
  • 8.Banegas J.R., Rodríguez F., De la Cruz J.J., Guallar P., Del Rey J. Blood pressure in Spain Distribution, awareness, control, and benefits of a reduction in average pressure. Hypertension. 1998;32:998–1002. doi: 10.1161/01.hyp.32.6.998. [DOI] [PubMed] [Google Scholar]
  • 9.Asunsolo A., Jiménez R., Ansede J.C., Gil A. Tratamiento combinado con doxazosina en pacientes hipertensos no controlados con monoterapia. Hipertensión. 1999;5:166–171. [Google Scholar]
  • 10.Lombera F., Barrios V., Soria F., Placer L., Cruz J.M., Tomas L. Guías de practica clínica de la Sociedad Española de cardiología en hipertensión arterial. Rev Esp Cardiol. 2000;53:66–90. doi: 10.1016/s0300-8932(00)75065-2. [DOI] [PubMed] [Google Scholar]
  • 11.Ruilope L.M., De la Sierra A., Moreno E., Fernández R., Garrido J., De la Figuera M. Prospective comparison of therapeutical attitudes in hypertensive type 2 diabetic patients uncontrolled on monoterapy. A randomized trial: the Edicta study. J Hypertens. 1999;17:1917–1923. doi: 10.1097/00004872-199917121-00022. [DOI] [PubMed] [Google Scholar]
  • 12.Haria M., Plosker G.L., Markham A. Felodipine/metoprolol: a review of the fixed dose controlled release formulation in the management of essential hypertension. Drugs. 2000;59:141–157. doi: 10.2165/00003495-200059010-00011. [DOI] [PubMed] [Google Scholar]
  • 13.Muñoz F., Gil B., Maldonado A., Cobo F., León M.T., Ceballos R. Beneficios de la asociación en dosis fija (verapamilo-trandolapril) en el tratamiento de la hipertensión. Hipertensión. 1999;8:291–297. [Google Scholar]
  • 14.Ambrosioni E. Pharmacoeconomics of hypertension management The place of combination therapy. Pharmacoeconomics. 2001;19:337–347. doi: 10.2165/00019053-200119040-00002. [DOI] [PubMed] [Google Scholar]
  • 15.Martell N., Luque M., Fernández C. Predictores de la respuesta antihipertensiva a monoterapia con lacidipino. Estudio CUPERI.N. Hipertensión. 1999;7:255–262. [Google Scholar]
  • 16.Redón J., Lozano J.V. Tratamiento antihipertensivo en el paciente de alto riesgo. Med Clin (Barc) 2000;1:33–34. [Google Scholar]
  • 17.Randomised, placebo-controlled trial of lisinopril in normotensive patients with insulin-dependent diabetes and normoalbuminuria or microalbuminuria The EUCLID Study Group. Lancet 349; 1997, 1787- 92 [PubMed]
  • 18.Reaven G.M., Clinkingbeard C., Jeppesen J., Maheux P., Pei D., Foote J. Comparison of the hemodynamic and metabolic effects of low-dose hydrochlorothiazide and lisinopril treatment in obese patients with high blood pressure. Am J Hypertens. 1995;8:461–466. doi: 10.1016/0895-7061(95)00055-T. [DOI] [PubMed] [Google Scholar]
  • 19.Brown M.J., Castaigne A., De Leeuw P.W., Mancia G., Palmer C.R., Rosenthal T. Influence of diabetes and type of hypertension on response to antyhipertensive treatment. Hypertension. 2000;35:1038–1042. doi: 10.1161/01.hyp.35.5.1038. [DOI] [PubMed] [Google Scholar]
  • 20.Black H.R., Kuller L.H., O’Rourke M.F., Weber M.A., Alderman M.H., Benetos A. The first of the Systolic and Pulse Pressure (SYPP) Working Group. J Hypertens. 1999;17(Suppl 5):S3–S14. [PubMed] [Google Scholar]
  • 21.Otero A., Pérez C., Esteban J., Armada E., García A. Presión del pulso y riesgo cardiovascular. Hipertensión. 2000:116. 17(n. o extraordinario): [Google Scholar]
  • 22.Fernández R., De la Figuera M., Gómez C. Eficacia del tratamiento antihipertensivo sobre la presión de pulso: estudio PREDIVERA. Hipertensión. 2001;1:7–13. [Google Scholar]
  • 23.Franklin S.S., Gustin W., Wong N.D., Larson M.G., Weber M.A., Kannel W.B. Hemodynamic patterns of age-related changes in blood pressure The Framingham Heart Study. Circulation. 1997;96:308–315. doi: 10.1161/01.cir.96.1.308. [DOI] [PubMed] [Google Scholar]
  • 24.Benetos A., Safar M., Rudnichi A., Smulyan H., Richard J.L., Ducimetiere P. Pulse pressure: a predictor of long-term mortality in a French male population. Hypertension. 1997;30:1410–1415. doi: 10.1161/01.hyp.30.6.1410. [DOI] [PubMed] [Google Scholar]
  • 25.Tranche S., Marín R., Prieto M.A., Hevia E. La presión de pulso como marcador de riesgo cardiovascular. Hipertensión. 2001;5:218–224. [Google Scholar]
  • 26.Albaladejo P., Bouaziz H., Duriez M. Angiotensin converting enzyme inhibition prevents the increase in aortic collagen in rats. Hypertensión. 1994;23:74–82. doi: 10.1161/01.hyp.23.1.74. [DOI] [PubMed] [Google Scholar]
  • 27.De las Heras N., Aragoncillo P., Maeso R., Vázquez-Pérez S., Navarro- Cid J., DeGasparo M. AT(1) receptor antagonism reduces endothelial dysfunction and intimal thickening in atherosclerotic rabbits. Hypertension. 1999;34:969–975. doi: 10.1161/01.hyp.34.4.969. [DOI] [PubMed] [Google Scholar]
  • 28.Murray N.H. Review of international safety data for lisinoprilhidroclorothiazide combination treatment. J Hum Hypertens. 1991;5:63–67. [PubMed] [Google Scholar]
  • 29.Pozuelo A,Taboada M, Fernández G, Rodríguez C, González J. Estudio multicéntrico sobre la seguridad y efectividad de enalapril 20 mg e hidroclorotiazida 6 mg en pacientes hipertensos. J Hypertens (ed. iberoamer.) 2000.
  • 30.Casona J. Fedra: base de datos de reacciones adversas. In: De abajo F.J., Madurga M., Olalla J.F., Palop R., editors. La farmacovigilancia en España. Instituto de Salud Carlos III; Madrid: 1992. pp. 71–88. [Google Scholar]
  • 31.De Abajo F.J., Martín-Bun M., Madurga M., Salcedo F. La farmacovigilancia en atención primaria. Farmacoterapia. 1992;5:234–241. [Google Scholar]

Articles from Atencion Primaria are provided here courtesy of Elsevier

RESOURCES