Industry Pulse
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INDUSTRY PULSE
© 2006 Adis Data Information BV. All rights reserved.
Industry Pulse (Editorial Development by Adis International, Italy) Contents Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 1. Combination Therapy in the Management of Hypertension: Role of Fixed Dose of Hydrochlorothiazide in Combination with Bisoprolol at Variable Doses (Sponsored by Merck Pharma) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Abstract
To help the reader keep up-to-date with the very latest developments in experimental and clinical research, this section of the journal aims to provide the reader with information selected by the journal sponsors regarding emerging clinical evidence on their compounds, new areas of research interest, and any other topic that might be potentially relevant to the reader.
1. Combination Therapy in the Management of Hypertension: Role of Fixed Dose of Hydrochlorothiazide in Combination with Bisoprolol at Variable Doses (Sponsored by Merck Pharma) Treatment of hypertension is rapidly changing and many different classes of drugs are now available; nevertheless, blood pressure control remains an unsolved clinical problem. Worldwide, the percentage of subjects with adequate blood pressure control is around 30%; in the US, where about 60% of hypertensive patients receive treatment, only 34% have a blood pressure that is effectively under control. Achieving blood pressure targets through ‘sequential monotherapy’ (one drug followed by another of a different class at the maximum tolerated dose) or through a ‘stepped-care method’ (monotherapy with gradual increments of the dose) presents many disadvantages, mainly related to the occurrence of an unfavourable efficacy/tolerability ratio. Hypertension presents a complex aetiology, involving different pathogenetic mechanisms. Therefore, about 50% of patients receiving treatment with only one class of drug do not achieve adequate pressure levels.[1] Thus, in order to reach an adequate control, it is often necessary to use two or more drugs, as shown in a large number of clinical trials. For example, in the ABCD (Appropriate Blood Pressure Control in Diabetes) study[2] each patient took on average 2.7 drugs, in the HOT (Hypertension
Optimal Treatment) study[3] they took 3.3 and in the UKPDS (UK Prospective Diabetes Study)[4] they took 2.8. It is for this reason that the interest in an approach characterised by the concomitant use of two or more classes of drugs, administered at a low dosage, is increasing. This approach has been recommended by the more recent guidelines for the treatment of hypertension.[5,6] The rationale for the use of a combination of two molecules belonging to different classes is based on the possibility of achieving an effictive blood pressure control (taking advantage of
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