Single-pill combination in the treatment of hypertension – a way to improve effectiveness and prognosis Review article
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Published:
Mar 31, 2014
Keywords:
hypertension, combination therapy, single-pill combination, cardiovascular prevention
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Abstract
Hypertension is a number one worldwide health problem and a major preventable risk factor for cardiovascular events. Achieving an optimal blood pressure (BP) target for patients with hypertension will often require more than one blood pressure lowering drug. Combination therapy confers many advantages such as better efficacy and a better tolerability. A better compliance and simplicity of treatment is noted with the single-pill combination. On the basis of large, outcome-driven trials, preferred dual combinations include an angiotensin converting enzyme inhibitor (ACEI) (or ARB) combined with a calcium channel blocker (CCB), or an ACEI (or ARB) combined with a diuretic. Some combinations are not recommended and may be harmful, such as dual renin angiotensin aldosterone system inhibition. Combination therapy as an initial approach is advocated in patients with a systolic blood pressure more than 20 mmHg and/or a diastolic blood pressure more than 10 mmHg above target and in patients with high CV risk. Using single-pill combinations has been stressed and favored in recent international guidelines.
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Nowek, P., Ławrynowicz, M., & Rynkiewicz, A. (2014). Single-pill combination in the treatment of hypertension – a way to improve effectiveness and prognosis. Medycyna Faktow (J EBM), 7(1(22), 7-13. Retrieved from https://journalsmededu.pl/index.php/jebm/article/view/2375
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References
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2. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. The JNC 7 Report. JAMA 2003; 289: 2560-2575.
3. Go A., Bauman M., Sallyann M. et al.: An Effective Approach to High Blood Pressure Control. A Science Advisory From the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention. JACC 2013 [online: 10.1016/j.jacc.2013.11.007].
4. Weber M., Schiffrin E., White W. et al.: Clinical Practice Guidelines for the Management of Hypertension in the Community. A Statement by the American Society of Hypertension and the International Society of Hypertension. The Journal of Clinical Hypertension 2013 [online: DOI: 10.1111/jch.12237].
5. Mancia G., Robert Fagard R., Narkiewicz K. et al.: ESH/ESC Guidelines for the management of arterial hypertension. European Heart Journal 2013; 34: 2159-2219.
6. Widecka K., Grodzicki T., Narkiewicz K. et al.: Zasady postępowania w nadciśnieniu tętniczym – 2011 rok. Wytyczne Polskiego Towarzystwa Nadciśnienia Tętniczego. Nadciśnienie Tętnicze 2011; 15: 55-85.
7. Tykarski A., Widecka K., Filipiak K.: Zalecenia ESH/ESC 2013 dotyczące postępowania w nadciśnieniu tętniczym. Próba komentarza na temat zmian i różnic w porównaniu z zaleceniami PTNT 2011. Nadciśnienie Tętnicze 2013; 17: 269-313.
8. [online: www.natpol.org/].
9. Dahlöf B., Sever P.S., Poulter N.R. et al.; Ascot Investigators: Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BLA): a multicentre randomised controlled trial. Lancet 2005; 366: 895-906.
10. Williams B., Lacy P.S., Thom S.M. et al.: Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) Study. Circulation 2006; 113: 1213-1225.
11. Rothwell P.M., Howard S.C., Dolan E.: Effects of β-blockers and calcium-channel blockers on within-individual variability in blood pressure and risk of stroke. The Lancet Neurology 2010; 9: 469-480. 12. 2007 Guidelines for the management of arterial hypertension. The Task Force For the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J. Hypertens. 2007; 25: 1105-1187.
13. [online. www.nice.org.uk].
14. Bangalore S., Kamalakkannan G., Parkar S. et al.: Fixed-dose combination improves medication compliance: a meta-analysis. Am. J. Med. 2007; 120: 713-719.
15. Parving H.H., Brenner B.M., McMurray J.J. et al.; ALTITUDE Investigators: Cardiorenal end points in a trial of aliskiren for type 2 diabetes. N. Engl. J. Med. 2012; 367(23): 2204-2213.
16. Yusuf S., Teo K.K., Pogue J. et al.; ONTARGET Investigators: Telmisartan, ramipril, or both in patients at high risk for vascular events. N. Engl. J. Med. 2008; 358(15): 1547-1559.
17. van Vark L.C., Bertrand M., Akkerhuis K.M. et al.: Angiotensin converting enzyme inhibitors reduce mortality in hypertension: a meta-analysis of randomized clinical trials of renin-angiotensin-aldosteron system inhibitors involving 158 998 patients. Eur. Heart J. 2012; 33: 2088-2097.
18. Savarese G., Costanzo P., Cleland J.G. et al.: A Meta-Analysis Reporting Effects of angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients Without Heart Failure. J. Am. Coll. Cardiol. 2013; 61: 131-42.
19. Gradman A., Parisé H., Lefebvre P. et al.: Initial combination therapy reduces the risk of cardiovascular events in hypertensive patients: a matched cohort study. Hypertens. 2013; 61: 309-318.
20. Jamerson K., Weber M., Bakris. G. et al.: Benazepril plus Amlodipine or Hydrochlorothiazide for Hypertension in High-Risk Patients. N. Engl. J. Med. 2008; 359: 2417-242.
21. Beckett N.S., Peters R., Fletcher A.E. et al.; HYVET Study Group: Treatment of hypertension in patients 80 years of age or older. N. Engl. J. Med. 2008; 358(18): 1887-1898.
22. Patel A., MacMahon S., Chalmers J. et al.; ADVANCE Collaborative Group: Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. Lancet 2007; 370(9590): 829-840.
23. DiNicolantonio J., Lavie C., O’Keefe J. et al.: Angiotensin-Converting Enzyme Inhibitors Are Equal: Focus on Ramipril and Perindopril. Postgraduate Medicine 2013; 4(125): 154-168.