Amlodipine/Atorvastatin Single-Pill Therapy for Blood Pressure and Lipid Goals in African Americans: Influence of the Metabolic Syndrome and Type 2 Diabetes Mellitus |
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| Authors: | Keith C Ferdinand MD ; John M Flack MD MPH ; Elijah Saunders MD ; Ronald Victor MD ; Karol Watson MD PhD ; Attila Kursun MD ; Michael J Jamieson MD FRCP ; Harry Shi MS |
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| Institution: | From the Association of Black Cardiologists, Atlanta, GA;;Wayne State University, Detroit, MI;;University of Maryland, Baltimore, MD;;University of Texas Southwestern Medical Center, Dallas, TX;;UCLA Medical Center, Los Angeles, CA;;and Pfizer Inc, New York, NY |
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| Abstract: | African Americans with diabetes ± the metabolic syndrome are at high risk for cardiovascular disease. This subanalysis of the Clinical Utility of Caduet in Simultaneously Achieving Blood Pressure and Lipid End Points (CAPABLE) trial studied attainment of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) and the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) goals by 8 flexibly titrated doses (5/10–10/80 mg) of amlodipine/atorvastatin single pill in 494 African Americans with hypertension and dyslipidemia, according to the presence of diabetes ± the metabolic syndrome. In 169 diabetic patients, the metabolic syndrome was associated with poorer BP goal attainment (38.5% vs 48.5% in diabetic patients without the metabolic syndrome). Among diabetic patients (± the metabolic syndrome) 61% to 62% reached LDL-C goal. More than 60% of patients with diabetes uncontrolled for LDL-C were maintained on suboptimal atorvastatin therapy (mean final dose: 29.9 mg vs maximum of 80 mg). Reluctance to intensify therapy to attain accepted targets in high-risk individuals suggests a degree of clinical inertia not explained by objective evidence of dose-dependent intolerance. |
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