Real-World Effectiveness of Monotherapy and Combination Therapy in Hypertension: A Cross-Sectional Study Using Ambulatory Blood Pressure Monitoring in a Tertiary Center

Background Ambulatory blood pressure monitoring (ABPM) is recommended to diagnose and monitor hypertension. However, evidence on ABPM in the context of blood pressure (BP) control, whether with monotherapy or combination therapy, is limited. Although current data support the use of combination therapy, little attention has been paid to patients who, despite receiving monotherapy, maintain blood pressure values below the control thresholds outlined for ABPM. Methods We conducted an observational study involving 340 patients, 59% (202 patients) of whom had a previous diagnosis of hypertension and were receiving treatment before monitoring. Results The majority of the patients were women (63%), with an average age of 52 years. Among the participants, 48% were treated with monotherapy, whereas 52% received combination therapy. The mean blood pressure in patients with hypertension was 127/75 mmHg, which was significantly different from that in individuals without a known diagnosis of hypertension. The most common circadian profile was dipper type, although the difference was not statistically significant. Differences were found among the other patterns (non-dipper, riser, and overdipper patterns) in relation to the antihypertensive regimen used. Blood pressure control rates ranged between 52% and 80%, considering 24-hour, daytime, and nighttime values, and were similar across the different treatment groups. Conclusion Although current evidence favors the initiation of combination antihypertensive therapy, our findings, which are consistent with those of previous studies, suggest that patients receiving long-term monotherapy can achieve ABPM blood pressure control comparable to that of patients receiving combination therapy. This implies that modifying the treatment regimen in such patients may not be necessary according to our findings.