Effects of a structured treatment algorithm on blood pressure goal rates in both stage 1 and stage 2 hypertension

This study analysed the efficacy of an angiotensin receptor blocker- based treatment algorithm for achieving goal blood pressure ( BP) in patients with stage 1 ( systolic BP ( SBP) 140 - 159mmHg or diastolic BP ( DBP) 90 - 99mmHg) or stage 2 ( SBP >= 160mmHg or DBP >= 100mmHg) hypertension. In this 24- week, open- label, multicentre study, patients followed a six- step algorithm until goal BP ( <= 130/ 85mmHg) was attained. Initially, olmesartan medoxomil 20 mg/ day was administered for 4 weeks. The regimen was modified every 4 weeks until goal BP was attained: increase olmesartan medoxomil to 40 mg/ day; add hydrochlorothiazide ( HCTZ) 12.5 mg/ day; increase HCTZ to 25 mg/ day; add amlodipine besylate 5 mg/ day; increase amlodipine besylate to 10 mg/ day. In patients with stage 1 hypertension, 80% ( 63/ 79) and 56% ( 44/ 79) achieved BP goals of <= 140/ 90mmHg and <= 130/ 85mmHg, respectively, with olmesartan medoxomil monotherapy ( 94% ( 74/ 79) and 89% ( 70/ 79) with olmesartan medoxomil/ HCTZ double therapy, and 96% ( 76/ 79) and 98% ( 77/ 79) with addition of amlodipine besylate ( triple therapy)). Mean SBP/ DBP reductions were 16.7/ 11.6, 24.8/ 15.8, and 26.4/ 16.5mmHg for mono-, double-, and triple- therapy, respectively. In patients with stage 2 hypertension, 42% ( 42/ 100) and 19% ( 19/ 100) achieved BP goals of p140/ 90mmHg and <= 130/ 85mmHg, respectively, with monotherapy ( 75% ( 75/ 100) and 54% ( 54/ 100) with double therapy, and 90% ( 90/ 100) and 81% ( 81/ 100) with triple- therapy). Mean SBP/ DBP reductions in stage 2 patients were 18.4/ 10.0, 32.7/ 16.3, and 39.1/ 19.4mmHg for mono-, double, and triple therapy, respectively. Overall, most patients with stage 1 or stage 2 hypertension achieved goal BP.