| アブストラクト | OBJECTIVES: We assessed rates of cardiovascular events, all-cause death, baseline risk factors, and treatment patterns in a population qualifying for initiation of dual combination blood pressure (BP)-lowering therapy. We also evaluated the association between dual versus monotherapy during follow-up and incidence of cardiovascular events. METHODS: This study utilized integrated databases in England: Clinical Practice Research Datalink, Hospital Episode Statistics, and Office for National Statistics. Individuals aged at least 18 years qualifying for dual therapy were identified during 15-year period (2005-2019). The primary endpoint was composite of nonfatal myocardial infarction, nonfatal stroke, hospitalization for heart failure, and cardiovascular death. The secondary endpoint was all-cause death. RESULTS: Total 1 426 079 individuals met selection criteria. The 15-year event rates for the primary and secondary endpoints were 27.1 and 32.6%, respectively. Atherosclerotic cardiovascular disease, diabetes on insulin therapy, heart failure, atrial fibrillation, chronic kidney disease, and advanced age were associated with two to four-fold higher risk of primary and secondary endpoints. The estimated hazard ratio for dual versus monotherapy as a time-varying covariate was 0.82 (95% confidence interval 0.81-0.83) for the primary endpoint. At variance with guidelines, monotherapy was most common treatment pattern over 5-year follow-up. CONCLUSION: Baseline characteristics conveying a multifold higher risk for cardiovascular events and all-cause death mostly represented nonmodifiable risk factors. Treatment with dual therapy as compared to monotherapy was associated with reduction in cardiovascular events. Monotherapy remained most common BP-lowering treatment indicating substantial opportunity for risk reduction by treatment intensification. |
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| 投稿者 | Coca, Antonio; Borghi, Claudio; Stergiou, George S; Ly, Nelly Francoise; Lee, Christopher; Tricotel, Aurore; Castelo-Branco, Anna; Khan, Irfan; Blacher, Jacques; Abdel-Moneim, Mohamed |
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| 組織名 | School of Health and Life Sciences, University Abat Oliba, CEU Universities,;Barcelona, Spain.;Department of Medicine, Science and Surgery, University of Bologna, Bologna,;Italy.;Hypertension Center STRIDE-7, School of Medicine, Third Department of Medicine,;Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece.;IQVIA, London, UK.;IQVIA, La Defense Cedex, France.;IQVIA, Solna, Sweden.;Sanofi, Bridgewater, New Jersey, USA.;Diagnosis and Therapeutic Center, Hopital Hotel-Dieu, AP-HP, Universite Paris;Cite, Paris, France.;Sanofi, Dubai.;Department of Family Medicine, College of Medicine, University of Sharjah,;Sharjah, United Arab Emirates. |
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