COMPARATIVE EFFECTIVENESS STUDY OF COMBINED ANTIHYPERTENSIVES FOR NIGERIAN PATIENTS

CHINWE VICTORIA UKWE; MAXWELL OGOCHUKWU ADIBE; OKAFOR CE; ANOSIKE C; ISAH A; IKE SO; ANISIUBA BC; NWURUKU GC

doi:10.22159/ajpcr.2020.v13i6.37399

Authors

CHINWE VICTORIA UKWE Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka.
MAXWELL OGOCHUKWU ADIBE Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka. https://orcid.org/0000-0001-5568-4401
OKAFOR CE Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University, Awka.
ANOSIKE C Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka.
ISAH A Department of Clinical Pharmacy and Pharmacy Management, Faculty of Pharmaceutical Sciences, University of Nigeria, Nsukka.
IKE SO Cardiology Unit, Department of Medicine, College of Medicine, University of Nigeria, Enugu Campus.
ANISIUBA BC Cardiology Unit, Department of Medicine, College of Medicine, University of Nigeria, Enugu Campus.
NWURUKU GC Department of Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State.

DOI:

https://doi.org/10.22159/ajpcr.2020.v13i6.37399

Keywords:

Antihypertensive medications, Combination therapy, Cost-effectiveness, Health status

Abstract

Objective: The objective of the study was to compare the clinical and economic effectiveness of four combination antihypertensives recommended for Nigerians.

Methods: An open, randomized, controlled, and longitudinal double-blind trial of four groups of antihypertensives combinations: Telmisartan/ chlorthalidone/amlodipine (TCA), TC, CA, and TA was conducted among hypertensive patients. The participants were recruited from three hospitals in Enugu, and randomly assigned to the study groups. The primary outcome for this study was blood pressure (BP) control, based on Joint National Committee-8 and cost per BP control. The secondary outcomes were cost per quality adjusted life years (QALY) and patients’ self-reported health status. Descriptive and inferential statistics were used for statistical analysis.

Results: Of the 110 patients enrolled in the study, more than half were women (55.5%). The mean age of patients was 54.93±12.38. The enrollees had hypertension for over 9 years (9.17±8.40). About 77% of the patients completed the study in all the groups except for TA (66.7%). There was no difference in BP in all the groups at baseline and at end-of-study (p>0.050). However, the probability of BP control was highest in TCA group (0.37±0.01), followed by TC group (0.23±0.02). The TA group showed the most favorable cost per QALY, then CA, TC, and TCA in that order. The group with the most favorable cost per BP control was TCA (70.92±0.04), then TA (94.16±0.05).

Conclusion: The triple combination therapy of TCA had the best cost per BP control in the management of hypertensive patients. It demonstrated the highest probability of BP control.

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References

World Health Organization. A Global Brief on Hypertension-silent Killer, Global Public Health Crisis: World Health Day 2013. Geneva, Switzerland: World Health Organization; 2015.

Ogah OS, Adebiyi AA, Oladapo OO, Adekunle AN, Oyebowale OM, Falase AO, et al. The changing patterns of heart disease in Nigeria: Data from the Ibadan outpatient cardiac registry. Circulation 2012;125:e673.

Ogah OS, Okpechi I, Chukwuonye II, Akinyemi JO, Onwubere BJ, Falase AO, et al. Blood pressure, prevalence of hypertension and hypertension related complications in Nigerian Africans: A review. World J Cardiol 2012;4:327-40.

Gradman AH, Parisé H, Lefebvre P, Falvey H, Lafeuille M, Duh MS. Initial combination therapy reduces the risk of cardiovascular events in hypertensive patients: A matched cohort study. Hypertension 2012;61:309-18.

Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension : Analysis of worldwide data. Lancet 2005;365:217-23.

Adeloye D, Basquill C, Aderemi AV, Thompson JY, Obi FA. An estimate of the prevalence of hypertension in Nigeria: A systematic review and meta-analysis. J Hypertens 2014;32:1-13.

World Health Organization. WHO Bulletin: Nigeria Wake Up to High Blood Pressure. Geneva: World Health Organization; 2013.

Salako B, Ayodele O, Kadiri S, Arije A. Assessment of blood pressure control in a black African population. Trop Cardiol 2002;28:3-6.

Gradman AH. Rationale for triple-combination therapy for management of high blood pressure. J Clin Hypertens (Greenwich) 2010;12:869-78.

Canbakan B. Rational approaches to the treatment of hypertension : Drug therapy-monotherapy, combination, or fixed-dose combination ? Kidney Int Suppl (2011) 2013;3:349-51.

Wald DS, Law M, Morris JK, Bestwick JP, Wald NJ. Combination therapy versus monotherapy in reducing blood pressure: Meta-analysis on 11,000 participants from 42 trials. Am J Med 2009;122:290-300.

Dennison-Himmelfarb C, Handler J, Lackland DT. 2014 Evidence-based guideline for the management of high blood pressure in adults report from the panel members appointed to the eighth joint national committee (JNC 8). JAMA 2014;1097:1-14.

Kalra S, Kalra B, Agrawal N. Combination therapy in hypertension : An update. Diabetol Metab Syndr 2010;2:44.

Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Joseph LJ, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressurethe JNC 7 report. JAMA 2003;289:2560-71.

Wright JM, Musini VM, Gill R. First-line drugs for hypertension. Cochrane Database Syst Rev 2018;4:CD001841.

Harman J, Walker ER, Charbonneau V, Akylbekova EL, Wyatt SB. Treatment of hypertension among African Americans : The Jackson heart study. J Clin Hypertens (Greenwich) 2014;15:367-74.

Ekwunife OI, Ezenduka CC, Uzoma BE. Evaluating the sensitivity of EQ-5D in a sample of patients with Type 2 diabetes mellitus in two tertiary health care facilities in Nigeria. BMC Res Notes 2016;9:24.

Murray C, Lauer J, Niessen L, Tomijima N, Rodgers A. Effectiveness and costs of intervention to lower systolic blood pressure and cholesterol: A global and regional analysis on reduction of cardiovascular-disease risk. Lancet 2003;361:717-25.

Edejer TT, Baltussen R, Adam T, Hutubessy R, Acharya A, Evans DB, et al. WHO Guid to Cost-effectiveness Analysis. Geneva: World Health Organization; 2003.

Woods B, Revill P, Sculpher M, Claxton K. Country-level cost-effectiveness thresholds: Initial estimates and the need for further research. Value Health 2016;19:929-35.

Stafylas P, Kourlaba G, Hatzikou M, Georgiopoulos D, Sarafidis P, Maniadakis N. Economic evaluation of a single-pill triple antihypertensive therapy with valsartan, amlodipine, and hydrochlorothiazide against its dual components. Cost Eff Resour Alloc 2015;13:10.

James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 Evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the eighth joint national committee (JNC 8). JAMA 2014;311:507-20.

Rosendorff C. Why are we still using hydrochlorothiazide? J Clin Hypertens (Greenwich) 2011;13:10-2.

Khalid B, Michael W, Daniel EH, Venkata MA, Venkata A, Tammy LB. Chlorthalidone and HCTZ Impacts on Platelet Activation. United States: Clinical Trial; 2014.