Evidence for the Treatment of Hypertension with Combination Therapy and the COPE Trial

Abstract

It is well-known that the majority of hypertensive patients will require several antihypertensive drugs to reach the target blood pressure. The Combination Therapy of Hypertension to Prevent Cardiovascular Events trial was an investigator-initiated multi-center study with PROBE design, and compared the dihydropyridine T/L-type calcium channel blocker benidipine based therapies with an angiotensin receptor blocker（ARB），a β-blocker（BB），or a thiazide diuretic（TD），and the results suggested that benidipine combined with a BB appeared to be less beneficial in reducing the risk of stroke compared with the benidipine-TD combination. We further evaluated the treatment effects on different stroke subtypes among the three benidipine-based regimens. All stroke events were sub-classified with the TOAST criteria. Although few differences in stroke subtypes were observed among the three treatment groups, multi-adjusted hazard ratios of the incidence of all types of stroke, hemorrhagic stroke and ischemic stroke were significantly higher with the benidipine-BB regimen than with the benidipine-TD regimen. The incidence of both hemorrhagic and ischemic stroke in the benidipine-ARB regimen was not different compared to the other two treatment regimens. This sub-analysis demonstrated that blood pressure-lowering therapy with a benidipine-TD regimen might be beneficial for hypertensive patients to prevent both hemorrhagic and ischemic stroke.