Page 11 - hypertension_newsletter

REFLECTIONS
Hypertension
Hypertension Global Newsletter #10 2026

Additionally, the study found a strong correlation with baseline BP: for every 10 mmHg lower a patient’s starting BP is, the efficacy
of monotherapies drops by an average of 1.3 mmHg. These findings reinforce that combination therapy is more effective than Hypertension
increasing the dose of a single antihypertensive agent.

Predicted reductions in SBP for different combinations of five antihypertensives
at different doses as single, dual, or triple therapy for a baseline SBP of 154 mmHg

Mean (95% prediction intervals) SBP reduction was estimated by adding the expected BP reduction from derived meta-regression equations for the respective
monotherapy components, accounting for a lower baseline BP for the second or third components. Different colours indicate efficacy intensity: low (red), moderate
(yellow), and high (green) correspond to SBP reductions of <10 mmHg, 10–19.9 mmHg, and ≥20 mmHg, respectively, from a baseline of 154 mmHg, with darker shades
corresponding to greater reductions. Mean reductions are larger for higher baseline BPs and smaller for lower baseline BPs.

The authors noted a few limitations to the study. The study design
restricted the researchers’ ability to identify individual effect CLINICAL PEARLS FROM THE FACULTY
modifiers. Furthermore, active drug comparisons and tolerability
were not evaluated, meaning the resulting efficacy calculator may
contain inaccuracies. Because of this, the authors caution that
prescribers should not rely entirely on expected changes in BP
based on this predictive model; nonetheless, these trial-derived
estimates provide a foundation for evidence-informed prescribing.
By moving away from trial-and-error dosing and utilizing the newly
developed efficacy classifications (low, moderate, high intensity),
clinicians can pre-emptively select the precise combination
therapies needed to rapidly and effectively close the global gap in
hypertension control.
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