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 <= 130/85 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 mg/amlodipine (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 V/A was progressively increased to V 160/A 5 mg; V160/A 7.5 mg; V160/A 10 mg; V 240/A 10 mg, and V 320/A 10 mg. In the monotherapy group, the regimen was progressively modified as following: V 240 mg; V 320 mg; V 320/A 5 mg; V 320/A 7.5 mg, and V 320/A 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 V/A combination approach may be more quickly effective than a conventional sequential monotherapy approach in achieving target BP in hypertensive patients with metabolic syndrome.