Monotherapy Versus Dual Therapy for Initial Treatment for Hypertension

Summary

To test whether the current custom of initiating treatment for hypertension with a single drug is less effective in the short-term than initial combination therapy, and results in the eventual need for comparatively more antihypertensive drug therapy.

Timeline

Start

2010-01

Primary completion

2014-12

Completion

2014-12

Outcome

Mixed primary results

paper Home systolic BP after initial monotherapy fell 4.9 mm Hg (range: 3.7-6.0 mm Hg) less over 32 weeks (P<0.001) than after initial combination PMID 29151036 ↗

paper but caught up at 32 weeks (difference 1.2 mm Hg [range: -0.4 to 2.8 mm Hg], P=0.13). PMID 29151036 ↗

Publications

• MacDonald TM, Williams B, Webb DJ, Morant S, Caulfield M, Cruickshank JK, Ford I, Sever P, Mackenzie IS, Padmanabhan S, McCann GP, Salsbury J, McInnes G, Brown MJ; British Hypertension Society Programme of Prevention And Treatment of Hypertension With Algorithm-based Therapy (PATHWAY). Combination Therapy Is Superior to Sequential Monotherapy for the Initial Treatment of Hypertension: A Double-Blind Randomized Controlled Trial. J Am Heart Assoc. 2017 Nov 18;6(11):e006986. doi: 10.1161/JAHA.117.006986.

Drugs

Evaluation	Drug	Modality	Dose	Route
Subject	Hydrochlorothiazide	Unknown	25 mg	—
Subject	Losartan	Other / unclassified	100 mg	—

Indications