Abstract
The use of fixed-dose combination antihypertensive agents (FDC) should improve compliance, increase achievement of blood pressure (BP) goals, and may reduce the costs of therapy. The use of FDC for initial therapy of hypertension (HTN) has historically been discouraged. To evaluate the cost-effectiveness of a FDC (trandolapril/verapamil, Tarka®) as initial therapy in high-risk hypertensive patients (pts). The short-term outcomes and costs of therapy of 25 high-risk pts (hypertension plus one or more cardiovascular risk factors) receiving FDC was compared to 250 high-risk hypertensive pts initiated on monotherapy. Pts receiving FDC were followed prospectively and data from the 250 monotherapy pts was collected retrospectively. BP control was defined as < 140/90 mmHg. Costs evaluated included drug acquisition (WAC), clinic visits, laboratory tests, and diagnostic procedures. Achievement of BP goals, absolute changes in BP (mmHg), and side effects were also evaluated. Baseline clinical characteristics and BP was not different between the groups. Of the 25 pts on FDC, 18/25 (72%) pts achieved BP control on that therapy compared to 35% (88/250) on monotherapy. Addition of another antihypertensive agent to FDC controlled BP in 88% (22/25) of pts, while 64% (160/250) of monotherapy pts were controlled with the addition of a second drug. The FDC group received an average of 1.32 treatments (FDC counted as a single therapy) compared to 1.99 treatments for monotherapy pts. At the end of 3 months, 24/25 (96%) FDC pts had BP control compared to 190/250 (76%) monotherapy pts. Side effects were reported in 32% of FDC pts compared to 45% of monotherapy pts. Average BP reduction was the same at 3 months in both groups. At 3 months, drug acquisition costs were the same in both groups, but the costs of clinic visits, laboratory tests, and diagnostic procedures were less in FDC pts compared to monotherapy pts. The use of FDC as initial therapy reduces the number of treatments and costs during the first 6 months of therapy. Costs after this time (predominated by drug acquisition costs) are expected to be similar between the groups. FDC should be considered as a potential first-line therapy in high-risk hypertensive pts who typically require multiple drugs to control BP. Am J Hypertens (2004) 17, 105A–105A; doi: 10.1016/j.amjhyper.2004.03.271