We read the article by J Polonia and co-worker [1] with great interest. The authors highlight a relevant topic since they found in a large group of patients with uncontrolled hypertension (HTN) who were diagnosed and followed-up by General Practitioners over the country, that therapeutic measures in accordance with guidelines, with a fixed combination candesartan/amlodipine, allowed to overall achieve HTN control at 12 weeks in 82% of previously uncontrolled HTN patients. Patients from three groups were studied, either medicated with monotherapy regimens, with combinations with hydrochlorothiazide or unmedicated. The only antihypertensive pharmacological therapy was either, low-, medium- and high- fixed candesartan/amlodipine combination, respectively of 8/5 or 16/5 or 16/10 mg/day (single tablet, morning intake) that were administered sequentially when the next lower dose failed to achieve adequate blood pressure control. Nevertheless, we would like to address three points to which we found no answers from the text of this important study. First, what was the degree of adherence of these patients to healthy lifestyle styles prior to inclusion in the study? Second, did some improvement of adherence to non-pharmacological measures along with the increase of adherence to the candesartan/amlodipine treatment could also contribute to the overall high blood pressure control in these patients? Third, one of the important missing pieces of information relates to which of the three doses of the candesartan/amlodipine combination, (i.e. 8/5 or 16/5 or 16/10 mg/day) and by what percentage were at the end required to achieve such blood pressure control both in all patients and also in each of the subgroups of patients who completed the study.
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Reference
- Polónia J, Marques Pereira R. Guidelines-based therapeutic strategies for controlling hypertension in non-controlled hypertensive patients followed by family physicians in primary health care in Portugal: the GPHT-PT study. Blood Press. 2024;33(1):2345887. doi: 10.1080/08037051.2024.2345887. Epub 2024 Apr 29.