ANTIHYPERTENSIVE EFFECTIVENESS OF A FIXED-DOSE COMBINATION OF RAMIPRIL/HYDROCHLOROTHIAZIDE IN THE GULF REGION: RESULTS FROM THE PACHA REGISTRY

Ramipril/hydrochlorothiazide (HCTZ) combined therapy can be used for the treatment of hypertension. We determined the percentage of patients who achieved optimum blood pressure control according to 2007 ESH recommendations after 3 months treatment with fixed-dose combination (FDC) ramipril/HCTZ and assessed tolerance to treatment. This non-interventional, prospective, multicentre, observational study was conducted in three Gulf countries (United Arab Emirates, Kuwait and Qatar). Patients with uncontrolled hypertension were treated with FDC ramipril/HCTZ (10/12.5 mg or 10/25 mg) for 3 months. Systolic (SBP) and diastolic (DBP) blood pressure were measured at baseline and after 1 and 3 months of treatment. Primary endpoint was the number of patients who achieved the target blood pressure of <140/90 mmHg (or <130/80 mmHg in diabetics) after 3 months of treatment. Secondary endpoints were the reduction in mean SBP and DBP in different patient subgroups and overall safety. A total of 409 patients were included in the efficacy analysis. The majority of patients (n=324, 79.2%) were given FDC ramipril/HCTZ 10/12.5 mg, while 85 (20.8%) received ramipril/HCTZ 10/25 mg. Ninety-four (23%) of these 409 patients had diabetes. There was no significant difference in the daily dose of ramipril/HCTZ FDC between patients with and without diabetes (78.7% of patients with diabetes and 79.4% of patients without received ramipril/HCTZ 10/12.5 mg; p = 0.89). After three months of treatment, 260 (63.6%; 95%CI: 58.9-68.3) ‎patients achieved the blood pressure target and 149 (36.4%) did not. The proportion of patients achieving the blood pressure target was significantly higher at three months than at one month (p<0.001). The proportion of patients achieving the blood pressure target was ‎considerably higher in non-diabetic patients than in those with diabetes (81.3% vs 4.3% respectively; p<0.001), irrespective of the ramipril/HCTZ dose. In conclusion, 10/12.5 mg and 10/25 mg FDC ramipril/HCTZ was effective at reducing both SDP and DBP to below guideline target levels in hypertensive patients, including those with diabetes, within 3 months of treatment. Ramipril/HCTZ was well tolerated.