Time to achieve blood pressure goal with a combination versus a conventional monotherapy approach in hypertensive patients with metabolic syndrome

The time to achieve a blood pressure (BP) goal ≤13085 mmHg with a combination versus a conventional monotherapy approach was evaluated in 308 hypertensive patients with metabolic syndrome. They were randomized to valsartan (V) 8 mgamlodipine (A) 5 mg combination or to V 160 mg monotherapy for 12 weeks and every 2 weeks, there was a titration in nonresponder patients: in the combination group VA was progressively increased to V 160A 5 mg; V160A 7.5 mg; V160A 10 mg; V 240A 10 mg, and V 320A 10 mg. In the monotherapy group, the regimen was progressively modified as following: V 240 mg; V 320 mg; V 320A 5 mg; V 320A 7.5 mg, and V 320A 10 mg. The mean time to achieve the BP goal was shorter in patients randomized to combination therapy compared to those randomized to conventional monotherapy (4.7 ± 2.7 weeks vs. 7.1 ± 3.9 weeks, respectively, p <0.001). The percentage of patients who achieved target BP in the combination approach group statistically exceeded that of the monotherapy treated one already after 2 weeks of treatment (30.5 vs. 14.9, p <0.01) and again after 4, 6, 8, and 10 weeks of treatment. Only at 12 weeks the percentage of normalized patients was similar in the two treatment groups (78.8 vs. 75.3, ns). These results suggest that initial therapy with a VA combination approach may be more quickly effective than a conventional sequential monotherapy approach in achieving target BP in hypertensive patients with metabolic syndrome.