Nearly Half of Uncontrolled Hypertensive Patients could be Controlled by High-dose Titration of Amlodipine in the Clinical Setting: The ACHIEVE Study

Kazuomi      Kario; Masato      Odawara; Kenjiro      Kimura; Koichi      Node

Abstract

The Amlodipine Cohort study by Internet-based research for Evaluation of Efficacy (ACHIEVE) was conducted to assess the efficacy of amlodipine 10mg daily. Hypertensive patients, who were up-titrated from amlodipine 5mg to 10mg daily, were enrolled by medical practitioners using web-based registration between March 9 and July 31, 2009. The primary outcomes were the blood pressure (BP) at clinic and at home, and the secondary outcome was rates of achievement who reached their target BP levels at clinic after 3 months. Seven-hundred and fifty three hypertensive patients were enrolled and 583 patients completed the follow-up study. Mean clinic BP decreased from 156.4/86.3 mmHg at baseline to 137.5/76.5mmHg, whereas mean home BP decreased from 151.5/83.9 mmHg at baseline to 139.6/75.2mmHg after 3 months of treatment. The reduction of these BPs was more pronounced among the patients with higher baseline BP values than among those with lower baseline levels. Sufficiently controlled hypertension, which is defined as a systolic BP < 140 mmHg for clinic BP and < 135 mmHg for home BP is 1.2% at baseline to 43.1% after 3 months of treatment. The survey showed that among poorly controlled hypertensive Japanese, high-dose titration from 5 mg to 10 mg daily of amlodipine showed marked reduction in both clinic and home BPs.

Keywords: Amlodipine, up-titration, home blood pressure, clinic blood pressure, ACHIEVE study, Antihypertensive Effects, masked hypertension, myocardial infarction, systolic blood pressure