Efficiency of monotherapy for blood pressure control: results of Ukrainian MAHNAT study

Abstract

The aim – to define a patient profile who underwent monotherapy, to study the therapy efficiency for blood pressure (BP) control and the prevalence rate of masked uncontrolled arterial hypertension (MUAH) among urban population in Ukraine and also to assess BP dynamics followed the correction of antihypertensive therapy.
Materials and methods. 1837 arterial hypertensive patients from 12 regional centers of Ukraine and Kyiv, treated with monotherapy, were included in the multi focused study MAHNAT. At the initial visit demographic data, anamnesis, cardiovascular risk factors and results of physical examination were estimated. Home BP monitoring (HBPM) and ambulatory BP monitoring (ABPM) were performed against the background of monotherapy and before the last visit against the background of modified antihypertensive treatment. After assessing the results of office and ambulatory BP measurements during the second visit a physician identified the further tactic of antihypertensive therapy and prescribed the medicine. In the majority of cases, the doctors preferred dual combination therapy with the original fixed-dose combination (FDC) of perindopril/amlodipine. Its efficacy and tolerability were assessed on the 2nd and 4th week of treatment.
Results and discussion. Effectiveness of monotherapy for the achievement of the target BP was 20.5 % according to office BP (BP < 140/90 mm Hg), 10.9 % – to HBPM (mean BP < 135/85 mm Hg) and 8.4 % – to ABPM (24-hour mean BP < 135/85 mm Hg). The efficient control process for target office BP was notified in 36.8 % patients and in 63.2 % ambulatory patients respectively. High normal BP (HR=1.54; 95 % CI 1.02–2.44; р=0.02), age over 55 (HR=0.39; 95 % CI 0.26–0.58; р<0.001) and diabetes mellitus (HR=2.44; 95 % CI 1.06–5.64; р=0.03) were the predictors of MUAH. Transfer to FDC perindopril/amlodipine resulted in decrease of systolic BP (SBP) by 15.6 % and diastolic BP (DBP) by 12 % after 4 weeks (p<0.001 for both parameters), which was accompanied with target office BP achievement at 92,8 % patients. The average home SBP/DBP declined by 15.1 %/11.3 % as well as average 24-hour SBP/DBP by 14.6 %/12.6 % (p<0.001 for both parameters). Treatment with FDC of perindopril/amlodipine promoted lowering the rate of MUAH from 63.2 to 27.5 %.
Conclusions. The effectiveness of monotherapy in the achievement of target BP is 20.5 % among the urban population of Ukraine; according to out-of-office measurements – 10.6 % and 8.3 % by HBPM and ABPM respectively. Transfer from monotherapy to FDC perindopril/amlodipine allowed to improve office BP significantly and to lower the frequency of MUAH by 27.5 %.