Korean J Health Promot KJHP Korean Journal of Health Promotion 2234-2141 2093-5676 Korean Society for Health Promotion and Disease Prevention 10.15384/kjhp.2019.19.1.16 Original Article Associated Factors for Target Blood Pressure Achievement after Triple Combination Therapy in Hypertensive Patients Jeon Ye Rim 1 Jung So Hyun 1 Kang Seo Young 1 Kim Young Sik 1 Jeon Tae Hee 2 Lee Sangyeoup 3 Yang Yun-Jun 4 Kim Seon-Mee 5 Yoon Jong Lull 6 Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. Department of Family Medicine, Veterans Health Service Medical Center, Seoul, Korea. Department of Family Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea. Department of Family Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea. Department of Family Medicine, Korea University Guro Hospital, Korea University School of Medicine, Seoul, Korea. Department of Family Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea. Corresponding author: Young Sik Kim, MD, MPH, PhD. Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. Tel: +82-2-3010-3811, Fax: +82-2-3010-3815, youngkim@amc.seoul.kr 03 2019 31 03 2019 19 1 16 24 21 01 2019 25 03 2019 26 03 2019 Copyright © 2019 Korean Society for Health Promotion and Disease Prevention 2019 Korean Society for Health Promotion and Disease Prevention This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background

The prevalence of hypertension reaches 29% in adults over 30 years of age in the Korean population; however, the control rate is merely 44%. The aim of this study was to investigate the associated factors for target blood pressure achievement after triple combination therapy in hypertensive patients.

 Methods

From February 2016 to May 2018, 10 family physicians recruited 348 patients, who newly started a triple combination antihypertensive medication. Target blood pressure was defined as a systolic blood pressure (SBP) <140 mmHg and diastolic blood pressure (DBP) <90 mmHg after 6 months of triple combination therapy. Multivariate logistic regression analyses were performed to analyze the associated factors for target blood pressure achievement.

 Results

Among the 348 study participants, 317 completed 6 months of treatment. The target achievement rate was 76.3% (242/317). The mean absolute difference and 95% confidence interval (CI) for the SBP and DBP were 10.8 mmHg (8.8 to 12.7) and 6.4 mmHg (5.1 to 7.8), respectively (P<0.05). The odds ratio (OR) for the target blood pressure achievement increased in those with college education or higher (OR, 2.69; 95% CI, 1.22–5.92), those with dyslipidemia (OR, 1.74; 95% CI, 1.01–2.99), and those who were satisfied with the medication (OR, 29.91; 95% CI, 3.70–241.92).

 Conclusions

The presence of dyslipidemia and patient's satisfaction with the medication were associated with target blood pressure achievement in our analyses. Our findings suggest the importance of patient's factor in the control of blood pressure.

 Hypertension Combination drug therapy Control Blood pressure World Health Organization Global status report on noncommunicable diseases 2014 Geneva World Health Organization 2014 Ezzati M Lopez AD Rodgers A Vander Hoom S Murray CJ Comparative Risk Assessment Collaborating Group Selected major risk factors and global and regional burden of disease Lancet 2002 360 9343 1347 1360 Korea Centers for Disease Control and Prevention (KCDC) Korea health statistics 2016: Korea National Health and Nutrition Examination Survey (KNHANES VII-1) [Internet] Seoul KCDC 2017 Accessed Mar 20, 2018 Available from: https://knhanes.cdc.go.kr/knhanes/sub04/sub04_03.do?class-Type=7 Petrella RJ Merikle EP Jones J Prevalence, treatment, and control of hypertension in primary care: gaps, trends, and opportunities J ClinHypertens (Greenwich) 2007 9 1 28 35 Agyemang C van Valkengoed I Koopmans R Stronks K Factors associated with hypertension awareness, treatment and control among ethnic groups in Amsterdam, the Netherlands: the SUNSET study J Hum Hypertens 2006 20 11 874 881 Sung YN Jang SM Lim DH Shin SY Song HJ Lee SH Prescribing patterns of antihypertensive drugs by outpatients with hypertension in 2007 Korean J Clin Pharm 2009 19 2 167 179 Korean Society Hypertension (KSH) Hypertension Epidemiology Research Working Group Kim HC Cho MC Korea hypertension fact sheet 2018 Clin Hypertens 2018 24 13 Dezii CM A retrospective study of persistence with single-pill combination therapy vs. concurrent two-pill therapy in patients with hypertension Manag Care 2009 9 9 Suppl 2 6 Bangalore S Kamalakkan G Parkar S Messerli FH Fixed-dose combinations improve medication compliance: a meta-analysis Am J Med 2007 120 8 713 719 Kato H Shiraishi T Ueda S Kubo E Shima T Nagura M Blood pressure control and satisfaction of hypertensive patients following a switch to combined drugs of an angiotensin receptor blocker and a calcium channel blocker in clinical practice of nephrology Clin Exp Nephrol 2015 19 3 465 473 Chobanian AV Bakris GL Black HR Cushman WC Green LA Izzo JL Jr The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report JAMA 2003 289 19 2560 2572 Matsumura K Arima H Tominaga M Ohtsubo T Sasaguri T Fujii K Impact of antihypertensive medication adherence on blood pressure control in hypertension: the COMFORT study QJM 2013 106 10 909 914 Rolnick SJ Pawloski PA Hedblom BD Asche SE Bruzek RJ Patient characteristics associated with medication adherence Clin Med Res 2013 11 2 54 65 Daiichi Sankyo, Inc Tribenzor (olmesartan medoxomil, amlodipine, hydrochlorothiazide) tablets [Internet] Parsippany Daiichi Sankyo, Inc 2010 Accessed Jun 1, 2014 Available from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/200175s000lbl.pdf Oparil S Melino M Lee J Fernandez V Heyrman R Triple therapy with olmesartan medoxomil, amlodipine besylate, and hydrochlorothizide in adult patients with hypertension: the TRINITY multicenter, randomized, double-blind, 12-week, paralled-group study Clin Ther 2010 32 7 1252 1269 Kereiakes DJ Chrysant SG Izzo JL Jr Littlejohn T 3rd Melino M Lee J Olmesartan/amlodipine/hydrochlorothizide in participants with hypertension and diabetes, chronic kidney disease, or chronic cardiovascular disease: a subanalysis of the multicenter, randomized, double-blind, parallel-group TRINITY study Cardiovasc Diabetol 2012 11 134 de la Sierra A Barrios V Blood pressure control with angiotensin receptor blocker-based three-drug combinations. Key trials Adv Ther 2012 29 5 401 415 Novartis Pharmaceuticals Corporation Exforge HCT (amlodipine, valsartan, hydrochlorothiazide) tablets [Internet] East Hanover Novartis Pharmaceuticals Corporation 2009 Accessed Sep 1, 2012 Available from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/022314lbl.pdf Calhoun DA Lacourcière Y Chiang YT Glazer RD Triple antihypertensive therapy with amlodipine, valsartan, and hydrochlorothiazide: a randomized clinical trial Hypertension 2009 54 1 32 39 Lee DH Choi YH Lee KH Kang DR Jee SH Nam CH Factors associated with hypertension control and antihypertensive medication among hypertensive patients in a community Korean J Prev Med 2003 36 3 289 297 Chang DM Park IS Yang JH Related factors of awareness, treatment, and control of hypertension in Korea: using the fourth Korea National Health & Nutrition Examination Survey J Digit Converg 2013 11 11 509 519 Mazzaglia G Ambrosioni E Alacqua M Filippi A Sessa E Immordino V Adherence to antihypertensive medications and cardiovascular morbidity among newly diagnosed hypertensive patients Circulation 2009 120 16 1598 1605 Kalra S Kalra B Agrawal N Oral insulin Diabetol Metab Syndr 2010 2 66 Webster R Salam A de Silva HA Selak V Rajapakse S Amarssekara S Fixed low-dose triple combination antihypertensive medication vs usual care for blood pressure control in patients with mild to moderate hypertension in Sri Lanka: a randomized clinical trial JAMA 2018 320 6 566 579 James PA Oparil S Carter BL Cushman WC Dennison-Himmelfarb C Handler J 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 5 507 520 Baseline characteristics of the 348 study participants

Abbreviations: BMI, body mass index; CVD, cardiovascular disease; DM, diabetes mellitus.

Values are presented as mean (standard deviation) or number (%).

 Changes in blood pressure after Sevikar HCT® (Daiichi Sankyo Europe GmbH, Pfaffenhofen, Germany) treatment

Abbreviations: AD, absolute difference; CI, confidence interval; HCT, hydrochlorothiazide; SD, standard deviation.

 Distribution of demographic and lifestyle factors according to achievement of target blood pressure goal

Abbreviations: BMI, body mass index; CVD, cardiovascular disease; DM, diabetes mellitus.

Values are presented as number (%).

aP for trend is presented for (2×n) data.

 Multivariate logistic regression analyses predicting factors associated with target blood pressure goal

Abbreviation: CVD, cardiovascular disease.

Values are presented as odds ratio (95% confidence interval).

aAdjusted for age, sex, and education.

 Patient's satisfaction with the Sevikar HCT® (Daiichi Sankyo Europe GmbH, Pfaffenhofen, Germany)

Values are presented as number (%).

Abbreviation: HCT, hydrochlorothiazide.