Single-pill combination therapy is the key to success, that is better together than alone Review article
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Published:
Mar 31, 2024
Keywords:
ramipril, bisoprolol, combined drug, cardiovascular diseases
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Abstract
Combined preparations are the future of treatment. Physicians are gaining more practical experience in their use and witnessing the emergence of new pharmaceutical combinations in the market. These combinations significantly improve cooperation with the patient and facilitate treatment. The selection of substances within a composite drug is crucial. Modern therapy aims not only for sustained blood pressure and/or heart rate control while maintaining a good quality of life but also for correcting hemodynamic and metabolic disorders and, above all, it aims to prolong life by reducing morbidity, and mortality due to coronary events, heart failure and strokes. This paper discusses the role that can be played by composite drug that is a combination of angiotensin-converting enzyme inhibitor – ramipril, which, in addition to its hypotensive effect, has outstanding cardio- and vasoprotective properties, and β-blocker – bisoprolol, which is a leader among preparations in its therapeutic group and has an established position in cardiac therapy.
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How to Cite
Barylski, M. (2024). Single-pill combination therapy is the key to success, that is better together than alone. Medycyna Faktow (J EBM), 17(1(62), 95-102. https://doi.org/10.24292/01.MF.0124.15
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References
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14. The DREAM Trial Investigators. Effect of ramipril on the incidence of diabetes. N Engl J Med. 2006; 355: 1551-62.
15. The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators. Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet. 1993; 342: 821-8.
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17. Pfeffer MA, Greaves SC, Arnold JM et al. Early versus delayed angiotensin-converting enzyme inhibition therapy in acute myocardial infarction. The healing and early afterload reducing therapy trial. Circulation. 1997; 95(12): 2643-51.
18. Kjoller-Hansen L, Steffensen R, Grande P. The Angiotensin-converting Enzyme Inhibition Post Revascularization Study (APRES). J Am Coll Cardiol. 2000; 35(4): 881-8.
19. Lièvre M, Guéret P, Gayet C et al. Ramipril-induced regression of left ventricular hypertrophy in treated hypertensive individuals. HYCAR Study Group. Hypertension. 1995; 25(1): 92-7.
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21. Lonn E, Yusuf S, Dzavik V et al.; SECURE Investigators. Effects of ramipril and vitamin E on atherosclerosis: the study to evaluate carotid ultrasound changes in patients treated with ramipril and vitamin E (SECURE). Circulation. 2001; 103(7): 919-25.
22. Ruggenenti P, Perna A, Gherardi G et al. Renoprotective properties of ACE-inhibition in non-diabetic nephropathies with non-nephrotic proteinuria. Lancet. 1999; 354: 359-64.
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25. Filipiak KJ, Tykarski A, Czarnecka D et al. Miejsce wazodylatacyjnych leków beta-adrenolitycznych w terapii nadciśnienia tętniczego i jego powikłań sercowo-naczyniowych. Stanowisko ekspertów. Nadciśnienie Tętnicze. 2010; 14: 421-33.
26. Mancia G, Dell’Oro R, Quarti-Trevano F et al. Angiotensin-sympathetic system interactions in cardiovascular and metabolic disease. J Hypertens Suppl. 2006; 24(1): S51-S56.
27. Strauss MH, Hall AS, Narkiewicz K. The Combination of Beta-Blockers and ACE Inhibitors Across the Spectrum of Cardiovascular Diseases. Cardiovasc Drugs Ther. 2023; 37(4): 757-70.
28. Prejbisz A, Klocek M, Gasowski J et al. Trends for beta-blockers use in a large cohort of Polish hypertensive patients: Pol-Fokus study. Arterial Hypertens. 2015; 19: 120-8.
29. Knuuti J, Wijns W, Saraste A et al.; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020; 41(3): 407-77.
30. Byrne RA, Rossello X, Coughlan JJ et al.; ESC Scientific Document Group. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023; 44(38): 3720-826.
31. McDonagh TA, Metra M, Adamo M et al.; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021; 42(36): 3599-726.
32. Hindricks G, Potpara T, Dagres N et al.; ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021; 42(5): 373-498.
2. Tykarski A, Filipiak KJ, Januszewicz A et al. Zasady postępowania w nadciśnieniu tętniczym – 2019 rok. Wytyczne Polskiego Towarzystwa Nadciśnienia Tętniczego. Nadciśnienie Tętnicze w Praktyce. 2019; 5(1): 1-84.
3. Claxton AJ, Cramer J, Pierce C et al. A systemic review of the associations between dose regimens and medication compliance. Clin Ther, 2001; 23: 1296-310.
4. Stephenson J. Noncompliance may cause half of antihypertensive drug “failures”. JAMA. 1999; 282: 313-4.
5. Gatley MS. To be taken as directed. JR Coll Gen Pract. 1968; 16: 39-44.
6. Saini SD, Schoenfeld P, Kaulback K et al. Effect of medication dosing frequency on adherence in chronic diseases. Am J Manag Care. 2009; 15: e22-e33.
7. Sokol MC, McGuigan KA, Verbrugge RR et al. Impact of medication adherence on hospitalization risk and healthcare cost. Med Care. 2005; 43: 521-30.
8. Bangalore S, Kamalakkannan G, Parkar S et al. Fixed-dose combinations improve medication compliance: a meta-analysis. Am J Med. 2007; 120: 713-9.
9. Egan BM, Bandyopadhyay D, Shaftman SR et al. Initial monotherapy and combination therapy and hypertension control the first year. Hypertension. 2012; 59: 1124-31.
10. Wilke T, Weisser B, Predel HG et al. Effects of Single Pill Combinations Compared to Identical Multi Pill Therapy on Outcomes in Hypertension, Dyslipidemia and Secondary Cardiovascular Prevention: The START-Study. Integr Blood Press Control. 2022; 15: 11-21.
11. The Heart Outcome Prevention Evaluation Study Investigators. Effect of angiotensin-converting enzyme, ramipril on cardiovascular events in high-risk patients. N Engl J Med. 2000; 342: 145-53.
12. HOPE/HOPE-TOO Study Investigators. Long-term effects of ramipril on cardiovascular events and on diabetes: results of the HOPE study extension. Circulation. 2005; 112(9): 1339-46.
13. Heart Outcomes Prevention Evaluation Study Investigators. Effect of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet. 2000; 355: 253-9.
14. The DREAM Trial Investigators. Effect of ramipril on the incidence of diabetes. N Engl J Med. 2006; 355: 1551-62.
15. The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators. Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet. 1993; 342: 821-8.
16. Hall AS, Murray GD, Ball SG; on behalf of the AIREX Study Investigators. Follow-up study of patients randomly allocated ramipril or placebo for heart failure after acute myocardial infarction: AIRE Extension (AIREX) Study. Lancet. 1997; 349: 1493-7.
17. Pfeffer MA, Greaves SC, Arnold JM et al. Early versus delayed angiotensin-converting enzyme inhibition therapy in acute myocardial infarction. The healing and early afterload reducing therapy trial. Circulation. 1997; 95(12): 2643-51.
18. Kjoller-Hansen L, Steffensen R, Grande P. The Angiotensin-converting Enzyme Inhibition Post Revascularization Study (APRES). J Am Coll Cardiol. 2000; 35(4): 881-8.
19. Lièvre M, Guéret P, Gayet C et al. Ramipril-induced regression of left ventricular hypertrophy in treated hypertensive individuals. HYCAR Study Group. Hypertension. 1995; 25(1): 92-7.
20. Agabiti-Rosei E, Ambrosioni E, Dal Palu C et al. ACE inhibitor ramipril is more effective than the beta-blocker atenolol in reducing left ventricular mass in hypertension. Results of the RACE (Ramipril Cardioprotective Evaluation) study on behalf of the RACE study group. J Hypertens. 1995; 13: 1325-34.
21. Lonn E, Yusuf S, Dzavik V et al.; SECURE Investigators. Effects of ramipril and vitamin E on atherosclerosis: the study to evaluate carotid ultrasound changes in patients treated with ramipril and vitamin E (SECURE). Circulation. 2001; 103(7): 919-25.
22. Ruggenenti P, Perna A, Gherardi G et al. Renoprotective properties of ACE-inhibition in non-diabetic nephropathies with non-nephrotic proteinuria. Lancet. 1999; 354: 359-64.
23. Charakterystyka produktu leczniczego Axtil, 2,5 mg, 5 mg, 10 mg, tabletki; 11.2020.
24. Filipiak KJ, Grabowski M, Opolski G. Farmakologia kliniczna leków beta-adrenolitycznych. In: Grodzicki T, Januszewicz A, Opolski G (ed). Leki beta-adrenolityczne w chorobach układu sercowo-naczyniowego. Via Medica, Gdańsk 2004.
25. Filipiak KJ, Tykarski A, Czarnecka D et al. Miejsce wazodylatacyjnych leków beta-adrenolitycznych w terapii nadciśnienia tętniczego i jego powikłań sercowo-naczyniowych. Stanowisko ekspertów. Nadciśnienie Tętnicze. 2010; 14: 421-33.
26. Mancia G, Dell’Oro R, Quarti-Trevano F et al. Angiotensin-sympathetic system interactions in cardiovascular and metabolic disease. J Hypertens Suppl. 2006; 24(1): S51-S56.
27. Strauss MH, Hall AS, Narkiewicz K. The Combination of Beta-Blockers and ACE Inhibitors Across the Spectrum of Cardiovascular Diseases. Cardiovasc Drugs Ther. 2023; 37(4): 757-70.
28. Prejbisz A, Klocek M, Gasowski J et al. Trends for beta-blockers use in a large cohort of Polish hypertensive patients: Pol-Fokus study. Arterial Hypertens. 2015; 19: 120-8.
29. Knuuti J, Wijns W, Saraste A et al.; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020; 41(3): 407-77.
30. Byrne RA, Rossello X, Coughlan JJ et al.; ESC Scientific Document Group. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023; 44(38): 3720-826.
31. McDonagh TA, Metra M, Adamo M et al.; ESC Scientific Document Group. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021; 42(36): 3599-726.
32. Hindricks G, Potpara T, Dagres N et al.; ESC Scientific Document Group. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021; 42(5): 373-498.