gms | German Medical Science

27. Wissenschaftlicher Kongress der Deutschen Hochdruckliga

Deutsche Liga zur Bekämpfung des hohen Blutdrucks – Deutsche Hypertonie Gesellschaft e. V.

26. bis 29.11.2003, Bonn

Better efficacy of initial low dose combination therapy with Preterax(R) vs. other strategies in hypertension (STRATHE)

Höhere Effektivität der initial niedrig-dosierten Fixkombination Preterax(R) vs. anderer Behandlungsstrategien in der Hypertonie

Meeting Abstract (Hypertonie 2003)

  • presenting/speaker M. Andréjak
  • F. Zannad
  • M. Laville
  • G. Duru
  • J. Mourad
  • B. Waeber

Hypertonie 2003. 27. Wissenschaftlicher Kongress der Deutschen Hochdruckliga. Bonn, 26.-29.11.2003. Düsseldorf, Köln: German Medical Science; 2004. Doc03hochV43

The electronic version of this article is the complete one and can be found online at:

Published: November 11, 2004

© 2004 Andréjak et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.




To compare 3 different currently recommended antihypertensive strategies (STRATHE: STRAtegies of Treatment in Hypertension Evaluation): Initial Low Dose Perindopril/Indapamide (Per/Ind) Combination (PreteraxÒ) strategy versus Sequential versus Step by Step strategies.


A 6- to 9-months, randomised, double-blind, controlled study. 533 Patients (160 £ SBP < 210mmHg and 95 £ DBP < 115mmHg) were randomised to

a) Initial Low Dose Combination Per/Ind strategy (Per 2mg/Ind 0.625mg to Per 4mg/Ind 1.25mg),

b) Sequential strategy (Atenolol 50mg, Losartan 50mg, Amlodipine 5mg), or

c) Step by step strategy (Valsartan 40mg, Valsartan 80mg, Valsartan 80mg/HCTZ 12.5mg).

Treatment could be adapted at M3 or M6 according to BP level. The main analysis criteria was based on the comparison of a predefined composite efficacy/safety ratio (=BP normalization without adverse events).


The initial Low Dose Combination strategy with Per/Ind showed a significant better efficacy/safety ratio compared with Sequential strategy (p=0.0015) and with Step by Step strategy (p=0.0042) (ITT, Intention-to-treat analysis). Systolic BP decrease was significantly superior in the Per/Ind group compared with Sequential and Step by Step strategies. BP normalisation rate (BP<140/90mmHg)in the Per/Ind group was significantly superior to the two other strategies [Tab. 1]. Tolerability was equivalent in the 3 groups with a tendency to a lower incidence of adverse events in Per/Ind group (Severe adverse events: 2.2% in Per/Ind vs. 5.5% in Sequential, 4.4% in Step by Step)


The new treatment strategy of initial Low Dose Combination therapy Per/ Ind recommended by ESH/ ESC resulted in a significant higher BP normalization rate and SBP decrease. Furthermore it showed a superior efficacy/ safety ratio than sequential or step by step strategies.