How can hypertensive patients be better treated? The contribution of combination therapy

Recent studies demonstrated that target blood pressure (BP) in treated hype rtensive patients should be below 140 mmHg for systolic blood pressure (SBP ) and below 90 mmHg for diastolic blood pressure (DBP). However, population studies from several countries have demonstrated that in clinical practice the proportion of controlled hypertensive patients is less than 30%. In or der to elucidate these questions in France we analysed a large population o f 145 000 subjects examined at the Centre d'Investigations Preventives et C liniques in Paris (IPC). Among those with high BP at the time of their IPC visit, only 20% received an antihypertensive treatment. Among those receivi ng an antihypertensive treatment, less than 27% (24% in men and 30% in wome n) presented with BP values less than 140 mmHg for SEP and less than 90 mmH g for DBP This analysis also showed that 72% of hypertensive patients prese nted with at least one modifiable associated cardiovascular risk factor and that more than 30% of hypertensive men and more than 25% of hypertensive w omen presented with at least two associated risk factors. The use of combin ation therapies could help to increase the percentage of well-controlled hy pertensive subjects. It has been shown that in order to reach this BP level , combination therapy should be used in more than two-thirds of the treated subjects. The trandolapril-verapamil combination is the first fixed combin ation of an angiotensin-converting enzyme inhibitor and a non-dihydropyridi ne calcium-channel blocker. Administered once daily, this combination reduc es BP more than a classic monotherapy. The effects of the trandolapril-vera pamil combination on risk factors are either neutral (metabolic parameters) , or even beneficial (reduction in heart rate).