In patients whose blood pressure (BP) is not controlled by a combination of 2 antihypertensive drugs, current guidelines recommend adding a third drug. In primary prevention, recommended triple therapies (ESH/ESC, NICE, French recos) are the combination of thiazides (DIU), renin-angiotensin system inhibitors (RAAS) and calcium channel blockers (CCB). The objective of the Trianon survey was to describe the antihypertensive triple therapies currently prescribed in France.Design and method:
Prospective, cross-sectional survey conducted by 258 cardiologists (liberal setting) in 2013–2014 and involving adult hypertensive patients receiving 3 antihypertensive drugs at stable dose for at least 8 weeks.Results:
The analysis involved 1055 patients (mean age 69 ± 11 years, males 59.2%, diabetics 32.3%, duration of hypertension 13.8 ± 8.3 years). 677 patients (64.1%) were in a primary prevention status. 439 patients (41.6%) were receiving a triple therapy matching recommendation (m3T = DIU + iRAAS + CCB), 224 patients (21.2%) were receiving a combination of RASS, CCB and BB (RCB), and 392 patients (37.2%) were receiving other combinations (O3T). Some characteristics of patients were different among groups.Results:
In a multinomial multivariate model RCB was associated with male gender (OR 1.58 [1.08;2.31]), angina (OR 3.50 [2.06;5.95]), history of myocardial infarction (OR 4.88 [2.39;9.96]), cardiac rhythm disorders (OR 2.48 [1.87;3.65]), asthma (OR 0.33 [0.12;0.96]), COPD (OR 0.32 [0.16;0.64]). O3T was associated with angina (OR 2.12 [1.29;3.49]), history of myocardial infarction (OR 3.19 [1.59;6.43]), cardiac rhythm disorders (OR 1.81 [1.30;2.53]), asthma (OR 0.36 [0.17;0.79]) and atrioventricular block (OR 1.92 [1.15;3.23]].Conclusions:
In primary prevention hypertensive patients needing triple therapies, the recommended combinations were prescribed in 76% of cases. The main determinant of alternative combinations including beta-blockers is a history of cardiac ischemic or rhythmic disease.