Posted by: Maria/MD Health Forum.com Team

Uncontrolled high blood pressure increases one’s risk to develop serious health problems such as heart diseases, kidney damage and stroke. Hypertension is considered as a major public health challenge worldwide. In 2000, it was estimated that the total number of adults with hypertension worldwide was 972 million, this number was predicted to increase by about 60% in 2025 which means that by then, 1.54 million adults will live with hypertension. There are many different classes of drugs available to control blood pressure. Doctors also follow numerous guidelines to help maintain their patients’ blood pressure within optimal levels. However, the result of a clinical trial published in the Journal of the American Heart Association, suggests that doctors may do away with the complexity of current treatment guidelines because following a simplified algorithm called STITCH improves blood pressure control. STITCH- Simplified Treatment Intervention to Control Hypertension, is a four-step algorithm which entails the use of low-dose fixed combination therapies.

The STITCH clinical trial was led by Dr. Ross D. Feldman of Robarts Research Institute. This study involved 2,104 patients with high blood pressure at 45 family practices in Ontario, Canada. The family physicians were asked to enroll their patients in either STITCH or usual Canadian guidelines. The target blood pressure were 140/90 and 130/80 for non-diabetic patients and diabetic patients, respectively. The investigators used cluster randomization to compare STITCH with the Canadian Hypertension Education Program. STITCH consists of the following steps:
1.initial therapy with a low-dose angiotensin-converting enzyme inhibitor/diuretic or angiotensin receptor blocker/diuretic combination;
2. increasing combination therapy to the highest tolerated dose;
3. addition of a calcium channel blocker and increase to highest dose tolerated
4. addition of a non-first-line antihypertensive drug
The Canadian guidelines, on the other hand, have 12 options for initial therapy that doctors can choose from, depending on the type of hypertension and the patient’s other existing medical conditions.
After 6 months, data was analyzed and researchers found out that the proportion of patients achieving target was significantly higher in the intervention group (64.76% vs 52.7%). Additionally, multivariate analysis showed that patients in the STITCH group increased their probability of reaching the target blood pressure by 20%. The results of the study suggests that majority of recently-diagnosed patients may respond to treatment better if they will be given a half tablet of a single pill combination drug (Angiotensin receptor blocker/diuretic combination or an ACE-inhibitor/diuretic) rather than starting the therapy with a single anti hypertensive agent.

According to Dr. Feldman, STITCH would favor both doctors and the patients. Since it is a simple four-step protocol, it is easier for doctors to follow. He also said that the result of the trial should urge hypertensive patients to go to their family doctors to be prescribed with single pill combinations. The researchers of this trial believe that the simplified algorithm is implementable and returning to step-care may be an important way towards treating hypertension. Additionally, they hypothesize that such approach may be applicable in managing other disease conditions.

References:

The Lancet Volume 365, Issue 9455, 15 January 2005, Pages 217-223
Global burden of hypertension: analysis of worldwide data

http://hyper.ahajournals.org/cgi/content/abstract/53/4/646 accessed 26.3.09

Hypertension. A Simplified Approach to the Treatment of Uncomplicated Hypertension
Ross D. Feldman; Guang Y. Zou; Margaret K. Vandervoort; Cindy J. Wong; Sigrid A.E. Nelson; Brian G. Feagan
https://asreports.lctrg.robarts.ca/portal/page/portal/RCTArticles/HYPERTENSIONAHA%20108%20123455v1.pdf accessed 27.3.09

Photo credit: Debbie Paula

Tags: high blood pressure, hypertension, stitch