Initial combination therapy reduces the risk of cardiovascular events in hypertensive patients Gradman AH, Parisé H, Lefebvre P, Falvey H, Lafeuille MH, Duh MS. Hypertension. 2013;61:

Study design Retrospective cohort study Electronic data charts from 2005 to 2009 Patients: adult uncontrolled blood pressure newly initiated on antihypertensive therapy (ACE inhibitors, CCBs, ARBs, or diuretics) given as a monotherapy or a drug combination (fixed or free) exclusion of patients with history of CV event Baseline period of 90 days before the treatment initiation 2 Gradman AH, Parisé H, Lefebvre P, Falvey H, Lafeuille MH, Duh MS. Hypertension. 2013;61:

Study end points Risk of CV events or all-cause death acute MI stroke/transient ischemic attack hospitalization for heart failure all-cause deaths Time to BP goal attainment Rates of health care resource use 3 Gradman AH, Parisé H, Lefebvre P, Falvey H, Lafeuille MH, Duh MS. Hypertension. 2013;61:

Main results 3309 Patients initiating monotherapy and subsequently switched to combination therapy (add-on cohort) combination therapy prescribed at a median 13.5 months after treatment initiation 1808 Patients initiating combination therapy 1762 patients matched the add-on cohort  Study population: 1762 x 2 = 3524 patients 67% stage 1 hypertension 33% stage 2 hypertension 4 Gradman AH, Parisé H, Lefebvre P, Falvey H, Lafeuille MH, Duh MS. Hypertension. 2013;61:

34% Risk reduction for CV events or all-cause death with initiating combination therapy 5 Gradman AH, Parisé H, Lefebvre P, Falvey H, Lafeuille MH, Duh MS. Hypertension. 2013;61:

Significant shorter median time to achieved BP target in the combination therapy 6 Gradman AH, Parisé H, Lefebvre P, Falvey H, Lafeuille MH, Duh MS. Hypertension. 2013;61:

Among patients achieving the BP target, a majority is without CV event during follow-up 7 Gradman AH, Parisé H, Lefebvre P, Falvey H, Lafeuille MH, Duh MS. Hypertension. 2013;61:

Interrelationship among exposure group, BP goal attainment, and CV events Achieving target BP after treatment initiation was associated with a statistically significant risk reduction of 23% for CV events or all-cause death The results indicated that an SBP >160 mm Hg at the last reading was associated with a 2.2-fold increased risk of developing a CV event or death compared with an SBP reading of 120 to 139 mm Hg Increase of 1 mm Hg in SBP was associated with a 2% increased risk of having a CV event 8 Gradman AH, Parisé H, Lefebvre P, Falvey H, Lafeuille MH, Duh MS. Hypertension. 2013;61:

Conclusion Initial combination therapy was associated with a significant risk reduction in cardiovascular events. More rapid achievement of target BP was found to be the main contributor to the estimated risk reduction. 9 Gradman AH, Parisé H, Lefebvre P, Falvey H, Lafeuille MH, Duh MS. Hypertension. 2013;61: