ArticleBMJ open2017
Relationship between initial therapy and blood pressure control for high-risk hypertension patients in the UK: a retrospective cohort study from the THIN general practice database.
Article in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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8 citing papers in PubMed, 1 synthesis or guideline pooled it, 15 citations in OpenAlex.
- First-line combination therapy versus first-line monotherapy for primary hypertension.The Cochrane database of systematic reviews · 2020Pooled it
- Trends in first-line monotherapy and combination therapy for hypertension in UK primary care.British journal of clinical pharmacology · 2026Article
- Real-World Effectiveness and Safety of Ramipril/Indapamide Combination Therapy in Essential Hypertension: A Retrospective Study on UK Primary Care Records.International journal of hypertension · 2026Article
- Cardiovascular outcomes of β-blocker-calcium channel blocker initial dual therapy vs. other initial dual therapies in Chinese patients with hypertension: A real-world retrospective study.Journal of clinical hypertension (Greenwich, Conn.) · 2023Article
- Impact of maternal hypertensive disorders on offspring's neurodevelopment: a longitudinal prospective cohort study in China.Pediatric research · 2020Article
- Impact of Socioeconomic Differences on Distributional Cost-effectiveness Analysis.Medical decision making : an international journal of the Society for Medical Decision Making · 2020Article
- The effect of community hypertension management on blood pressure control and its determinants in southwest China.International health · 2020Article
- Effectiveness of two-drug therapy versus monotherapy as initial regimen in hypertension: A propensity score-matched cohort study in the UK Clinical Practice Research Datalink.Pharmacoepidemiology and drug safety · 2019Observational
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4 authors at 3 institutions in 2 countries.
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No grant is acknowledged in the PubMed record.
Abstract
objectiveTo examine the UK practice patterns in treating newly diagnosed hypertension and to determine whether subgroups of high-risk patients are more or less likely to follow particular therapeutic protocols and to reach blood pressure goals.
designRetrospective cohort study.
settingThis study examined adults in The Health Improvement Network (THIN) UK general practice medical records database who were initiated on medication for hypertension.
participants48 131 patients with essential hypertension diagnosed between 2008 and 2010 who were registered with a participating practice for a minimum of 13 months prior to, and 6 months following, initiation of therapy. We excluded patients with gestational hypertension or secondary hypertension. Patients were classified into risk groups based on blood pressure readings and comorbid conditions. PRIMARY AND SECONDARY OUTCOME MEASURES: Odds of receiving single versus fixed or free-drug combination therapy and odds of achieving blood pressure control were assessed using multivariable logistic regression.
resultsThe vast majority of patients (95.8%) were initiated on single drug therapy. Patients with high cardiovascular risk (patients with grade 2-3 hypertension or those with high normal/grade 1 hypertension plus at least one cardiovascular condition pretreatment) had a statistically significant benefit of starting immediately on combination therapy when blood pressure control was the desired goal (OR: 1.23; 95% CI: 1.06 to 1.42) but, surprisingly, were less likely than patients with no risk factors to receive combination therapy (OR: 0.53; 95% CI: 0.47 to 0.59).
conclusionsOur results suggest that combination therapy may be indicated for patients with high cardiovascular risk, who accounted for 60.6% of our study population. The National Institute for Health and Care Excellence guideline CG34 of 2006 (in effect during the study period) recommended starting with single drug class therapy for most patients, and this advice does seem to have been followed even in cases where a more aggressive approach might have been considered.
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