Service of Internal Medicine and Cardiology, Department of Internal Medicine and Subspecialties, Douala General Hospital, 4856, Douala, Cameroon.
Lown Scholar Programs, Cardiovascular Health, Harvard T H Chan School of Public Health, Boston, USA.
Adv Ther. 2023 May;40(5):2282-2295. doi: 10.1007/s12325-023-02461-w. Epub 2023 Mar 14.
Hypertension is the leading cause of morbidity and mortality in sub-Saharan Africa (SSA). Current guidelines recommend using two or more antihypertensive agents in single pill combinations (SPCs) to treat hypertension, but data from African patients that support these recommendations are lacking. We assessed the effectiveness and tolerance of three SPCs in lowering blood pressure (BP) amongst hypertensive patients in Douala.
All patients included in the hypertension registry of the Douala General Hospital and the Douala Cardiovascular Center between January 2010 and May 2020, and receiving a two-drug SPCs (renin-angiotensin system inhibitors (RAASi) + diuretics (DIU), calcium channel blockers (CCB) + RAASi, or DIU + CCB) were tracked from baseline through 16 weeks. Our primary outcome was a decrease in systolic BP (SBP) from baseline up to 16 weeks after initiation of treatment. A mixed linear repeated model was used to evaluate the change of SBP from baseline to week 16, while controlling for age, gender, and baseline SBP. Statistical significance was set at p < 0.05.
Of 377 participants on two-drug SPCs, 123 were on CCB + DIU, 96 on RAASi + CCB, and 158 on RAASi + DIU. The mean age was 54.6 (± 11.2) years. At baseline, participants on RAASi + CCB presented with slightly higher SBP compared to the other two groups. Overall, the SBP decreased by 34.3 (± 14.2) mmHg from baseline values and this was comparable across the three groups of SPCs (p = 0.118). The control rate after 16 weeks of follow-up was 62.3% with no significant difference between groups. The occurrence of adverse events was 3.4% and was comparable among the three groups.
The three two-drug SPCs were highly effective in reducing and controlling BP with low and similar rates of adverse effects. Long-term data documenting safety and whether these agents exert a differential cardiovascular effect in addition to and independent of their BP-lowering effect are needed for SSA populations.
高血压是撒哈拉以南非洲（SSA）发病率和死亡率的主要原因。目前的指南建议使用两种或更多种降压药物联合单药治疗（SPC）治疗高血压，但缺乏支持这些建议的非洲患者数据。我们评估了三种 SPC 在降低杜阿拉高血压患者血压方面的有效性和耐受性。
2010 年 1 月至 2020 年 5 月期间，在杜阿拉总医院和杜阿拉心血管中心高血压登记处接受二药 SPC（肾素-血管紧张素系统抑制剂（RAASi）+利尿剂（DIU）、钙通道阻滞剂（CCB）+RAASi 或 DIU+CCB）的所有患者均从基线随访至 16 周。我们的主要结局是治疗开始后 16 周内收缩压（SBP）从基线下降。使用混合线性重复模型来评估从基线到第 16 周 SBP 的变化，同时控制年龄、性别和基线 SBP。统计学意义设定为 p<0.05。
在接受二药 SPC 的 377 名患者中，123 名服用 CCB+DIU，96 名服用 RAASi+CCB，158 名服用 RAASi+DIU。平均年龄为 54.6（±11.2）岁。在基线时，服用 RAASi+CCB 的患者的 SBP 略高于其他两组。总体而言，SBP 从基线值下降了 34.3（±14.2）mmHg，这在三组 SPC 中是可比的（p=0.118）。16 周随访后的控制率为 62.3%，各组之间无显著差异。不良事件发生率为 3.4%，三组之间无差异。
三种二药 SPC 在降低和控制血压方面非常有效，且不良反应发生率低且相似。需要在 SSA 人群中进行长期数据记录以评估安全性以及这些药物除降压作用外是否具有独立于降压作用的差异心血管效应。
