Observational studyPharmacoepidemiology and drug safety2019
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.
Observational study in Pharmacoepidemiology and drug safety, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 25 citations in OpenAlex.
- [Cardiovascular preventive recommendations. PAPPS 2024 thematic updates].Atencion primaria · 2024Guideline
- Low-Dose Telmisartan/Amlodipine in Essential Hypertension: A Phase III Trial.Journal of clinical hypertension (Greenwich, Conn.) · 2026Trial
- Triple and quadruple combination antihypertensive therapy in untreated individuals.Journal of human hypertension · 2026Review
- Challenges and Perspectives in Optimising the Treatment of Arterial Hypertension: Role of the Ramipril-Amlodipine-Hydrochlorothiazide Single-Pill Combination.High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension · 2026Review
- Trends in first-line monotherapy and combination therapy for hypertension in UK primary care.British journal of clinical pharmacology · 2026Article
- Prevalence and Medical Treatment of Arterial Hypertension and Hypercholesterolemia in Germany: a Nationwide questionnaire-based Survey in Medical Practices.High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension · 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
- Simplified Approach to Managing Newly Diagnosed Patients with Mild-to-Moderate Hypertension in Routine Clinical Practice.Advances in therapy · 2025Observational
- Clinical efficacy and psychological benefits of combination therapy in elderly patients with hypertension.American journal of translational research · 2025Article
- Global consumption patterns of combination hypertension medication: An analysis of pharmaceutical sales data from 2010-2021.PLOS global public health · 2024Article
- Laparoscopic adrenalectomy performed by a general surgeon on functioning adrenal tumors: Treatment outcomes and risk prediction of persistent hypertension.Qatar medical journal · 2024Article
- Evaluating the Performance of High-Dimensional Propensity Scores Compared with Standard Propensity Scores for Comparing Antihypertensive Therapies in the CPRD GOLD Database.Cardiology and therapy · 2023Article
- Prediction model for drug response of acute myeloid leukemia patients.NPJ precision oncology · 2023Article
- Article
- Hypertension as a risk factor for atherosclerosis: Cardiovascular risk assessment.Frontiers in cardiovascular medicine · 2022Review
- Effective Treatment Recommendations for Type 2 Diabetes Management Using Reinforcement Learning: Treatment Recommendation Model Development and Validation.Journal of medical Internet research · 2021Article
- Big data and real-world data-based medicine in the management of hypertension.Hypertension research : official journal of the Japanese Society of Hypertension · 2021Review
- Effect of patient and treatment factors on persistence with antihypertensive treatment: A population-based study.PloS one · 2021Observational
- Fixed-Dose Combination Medications for Treating Hypertension: A Review of Effectiveness, Safety, and Challenges.Current hypertension reports · 2020Review
- 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
Corrections and comments
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Authors and funding
6 authors at 4 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeTo compare the effectiveness on blood pressure (BP) of initial two-drug therapy versus monotherapy in hypertensive patients.
methodsUsing the Clinical Practice Research Datalink, linked with Hospital Episode Statistics and Office for National Statistics, we identified a cohort of adults with uncontrolled hypertension, initiating one or two antihypertensive drug classes between 2006 and 2014. New users of two drugs and monotherapy were matched 1:2 by propensity score. Main exposure was "as-treated," ie, until first regimen change. Primary and secondary endpoints were systolic and diastolic BP control and major adverse cardiovascular event (MACE), respectively. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using Cox proportional hazard models.
resultsOf 54 523 eligible patients, 3256 (6.0%) were initiated to a two-drug combination. Of these, 2807 were matched to 5614 monotherapy users. Mean exposure duration was 12.7 months, with 76.5% patients changing their initial regimen. Two-drug therapy was associated with a clinically significant BP control increase in all hypertensive patients (HR = 1.17 [95%CI: 1.09-1.26]), more so in patients with grade 2-3 hypertension (HR = 1.28 [1.17-1.41]). An increase of 27% in BP control (HR = 1.27 [1.08-1.49]) was observed in patients initiating an ACEi+CCB combination compared with initiators of either single class. No significant association was found between two-drug therapy and MACE. Several sensitivity analyses confirmed the main findings.
conclusionsFew patients initiated therapy with two drugs, reflecting UK guidelines' recommendation to start with monotherapy. This study supports the greater effectiveness of two-drug therapy as the initial regimen for BP control.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.