Valsartan's single-pill combination therapy significantly reduces BP in hypertensive patients

Uncontrolled hypertension can contribute to cardiovascular disease (CVD) leading to heart failure (HF), stroke, coronary artery disease and kidney disease and is an important health issue. Prescribing a single-pill combination therapy provides the benefit of having an additive BP-lowering effect and reduced adverse effects, as individual drugs in the SPEC therapy are within the tolerable dose range. BP control is achieved quickly and this regimen may help lower the pill burden as medications are indicated for chronic use. The usual combinations of two or three antihypertensive medications include renin-angiotensin-aldosterone system (RAAS) blocker with calcium channel blocker (CCB) and RAAS blocker plus CCB coupled with diuretic, respectively.

To summarize, SPC therapies possess a combined BP-lowering effect and may improve compliance with treatment. Ahmad K. M. Yusof, Cardiology Department, Institut Jantung Negara, Kuala Lumpur, Malaysia, and colleagues aimed to provide real-world evidence on the effectiveness of amlodipine/valsartan (Aml/Val) and amlodipine/ valsartan/hydrochlorothiazide (Aml/Val/HCTZ) SPC therapies for achieving blood pressure control in VaREAL study in hypertension patients from 2013 to 2017.

In the retrospective study, the researchers extracted data from the hybrid medical records of patients from the Institut Jantung Negara (IJN), Malaysia. It included adults with established diagnoses of hypertension and on the prescription of valsartan's single-pill combination therapies as part of routine medical care, with ≥ 1 year of follow-up.

The primary endpoint of the study was determined as the proportion of patients achieving therapeutic BP control (BP < 140/90 mmHg). Secondary outcomes were a change from baseline (CFB) in diastolic BP (DBP) and systolic BP (SBP), and subgroup analysis was based on baseline SBP categories and diabetes presence.

A total of 409 hypertensive patients were included in the study. The mean age of the population was 65.1 years old, with male predominance (61.6%).

Based on the study, the researchers reported the following findings:

• The proportion of patients achieving target BP between baseline and follow-up was 57.0%.
• Mean CFB in SBP and DBP were recorded as 19.52 mmHg and 7.47 mmHg, respectively.
• Over half of the patients achieved the target BP in all subgroups categorized by SBP at baseline, except the subgroup of SBP 160 mmHg-179 mmHg.
• SPC therapies were continued in 97.3% of patients at 1-year follow-up.

"Our study highlights the effectiveness of Val-based SPC therapies in hypertension treatment in a real-world clinical practice over a follow-up of 1 year," the researchers wrote. "In the study, 57% of patients achieved therapeutic BP control which was much higher than reported in the literature."

"Thus, SPC therapies should be considered as the preferred option for treatment of hypertensive patients," they concluded.

Reference:

Yusof, Ahmad K M., et al. "Effectiveness of Valsartan's Single-Pill Combination Therapies On Blood Pressure Control in Hypertensive Patients: Malaysian Single-Centre Real-World Experience." The Malaysian Journal of Medical Sciences : MJMS, vol. 30, no. 5, 2023, pp. 116-128.