Fixed-dose combination vs. add-on approach as initial treatment in patients with ambulatory systolic hypertension
Bibliographic record
Abstract
More than one drug is often needed in treating patients with the systolic form of hypertension. The efficacy of 2 types of antihypertensive combination therapy on 24-hour blood pressure profile was compared in patients who have elevated systolic blood pressure (SBP) both in clinic (>150mmHg) and during daytime ambulatory monitoring (>135mmHg). Eligible patients (n=121; 40F/81M) were randomized to received a once daily morning regimen with either Losartan (L) 50 mg plus hydrochlorothiazide (H) 12.5 mg (Group 1; n=60) or H 12.5 mg (Group 2; n=61). If the target SBP (mean daytime ambulatory ≤ 135 mm Hg) was not achieved after 6 weeks of treatment, drug regimens were titrated up to L 100 mg plus H 25 mg or to H 12,5 mg plus Atenolol 50 mg for an additional 6-week period. Amlodipine 5 mg was then added as a third drug in combination for a further 6 weeks in non responders of each group. Clinic and ambulatory BP were measured after 6, 12 and 18 weeks. Daytime ambulatory systolic/diastolic BP were comparable in Group 1 (152.6/87.0 mmHg) and Group 2 (154.3/89.0 mmHg) at baseline. Average decreases were −9.8/−4.4, −16.0/−8.0 and −22.3/−11.3 mmHg in Group 1 and −2.2/−0.1, −12.3/−8.1 and −20.1/−12.0 mmHg in Group 2, after 6, 12 and 18 weeks, respectively. All reductions were significant (p<0.0001) except for Group 2 at 6 weeks. Although BP reductions at end point (18 weeks) were comparable between groups, the percentage of patients who reached the goal daytime ambulatory SBP was significantly higher (p=0.008) in Group 1 (63.5%) than in Group 2 (37.5%). Furthermore, twice as many patients in Group 1 (30%) acheived the goal daytime SBP with no more than 2 drugs, as compared to Group 2 (14.7%; p=0.03 vs. Group 1). The change from baseline to week 18 in mean daytime ambulatory pulse pressure was also significantly greater (p<0.05) in Group 1 (-11.0 mmHg) than in Group 2 (-8.1 mmHg). Tolerability was better in Group 1 with a 40.0% incidence of possibly to definitively related adverse events, compared to 65.6% in Group 2 (p=0.006 vs. Group 1). In conclusion, initiating an antihypertensive therapy by the combination of L plus H in patients with predominant systolic hypertension allows to reach goal BP faster, in a higher proportion of patients, with fewer adverse events and a lesser need for a third drug than the conventional add-on approach of H plus a beta-blocker.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".