Role of triple combination therapy in the treatment of hypertension Review article
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Published:
Dec 31, 2024
Keywords:
hypertension, triple therapy, single pill combination, monotherapy, adherence
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Abstract
The latest European Society of Cardiology guidelines categorize blood pressure as normal (<120/70 mmHg), elevated (120– 139/70–89 mmHg), and hypertension (≥140/90 mmHg). Combination therapy remains the first-line standard in the treatment of hypertension, as it is more effective than monotherapy. The recommended first-line drugs include angiotensin convertase inhibitors, angiotensin receptor blockers, calcium channel blockers, and thiazide and thiazide-like diuretics. Perindopril, amlodipine, and indapamide are medications with proven efficacy in the treatment of hypertension, supported by years of clinical experience. Beyond their antihypertensive effects, these drugs exhibit multiple benefits, including cardiovascular risk reduction, nephroprotective and anti-inflammatory properties as well as regulation of glucose metabolism. Using these medications in the form of single-pill combinations offers enhanced antihypertensive effects, improved adherence, and reduced healthcare costs for patients.
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How to Cite
Skwarek, A., & Ozierański, K. (2024). Role of triple combination therapy in the treatment of hypertension. Medycyna Faktow (J EBM), 17(4(65), 496-500. https://doi.org/10.24292/01.MF.0424.10
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References
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8. Weder AB. The Avoiding Cardiovascular events through COMbination therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial: a comparison of first-line combination therapies. Expert Opin Pharmacother. 2005; 6(2): 275-81.
9. Nissen SE, Tuzcu EM, Libby P et al. Effect of antihypertensive agents on cardiovascular events in patients with coronary disease and normal blood pressure: the CAMELOT study: a randomized controlled trial. JAMA. 2004; 292(18): 2217-25.
10. Williams B, Lacy PS, Thom SM 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(9): 1213-25.
11. Roush GC, Sica DA. Diuretics for Hypertension: A Review and Update. American Journal of Hypertension. 2016; 29(10): 1130-7.
12. McNally RJ, Morselli F, Farukh B et al. A review of the prescribing trend of thiazide-type and thiazide-like diuretics in hypertension: A UK perspective. Br J Clin Pharmacol. 2019; 85(12): 2707-13.
13. Robinson DM, Wellington K. Indapamide sustained release: a review of its use in the treatment of hypertension. Drugs. 2006; 66(2): 257-71.
14. PATS Collaborating Group. Post-stroke antihypertensive treatment study. A preliminary result. Chin Med J (Engl). 1995; 108(9): 710-7.
15. Marazzi G, Pelliccia F, Campolongo G et al. Greater cardiovascular risk reduction with once-daily fixed combination of three antihypertensive agents and statin versus free-drug combination: The ALL-IN-ONE trial. Int J Cardiol. 2016; 222: 885-7.
16. Nedogoda SV, Stojanov VJ. Single-Pill Combination of Perindopril/Indapamide/Amlodipine in Patients with Uncontrolled Hypertension: A Randomized Controlled Trial. Cardiol Ther. 2017; 6(1): 91-104.
17. Mourad JJ, Amodeo C, de Champvallins M et al. Blood pressure-lowering efficacy and safety of perindopril/indapamide/amlodipine single-pill combination in patients with uncontrolled essential hypertension: a multicenter, randomized, double-blind, controlled trial. J Hypertens. 2017; 35(7): 1481-95.
18. Brguljan J, Chazova IE, Gaciong Z et al. Precious trial confirms safety and efficacy of guideline’s single-pill combination strategy. J Hypertens. 2021; 39: e415.
19. Shelest BO, Hryhorian OV, Sarkis-Ivanova VV et al. Therapeutic strategy in patients with long-lasting essential hypertension with comorbid type 2 diabetes mellitus and obesity. Arterial Hypertension. 2021; 25(1): 39-46.
20. Snyman JR, Bortolotto LA, Degli Esposti L et al. A real-world analysis of outcomes and healthcare costs of patients on perindopril/indapamide/amlodipine single-pill vs. multiple-pill combination in Italy. J Hypertens. 2024; 42(1): 136-42.
2. van Vark LC, Bertrand M, Akkerhuis KM et al. Angiotensin-converting enzyme inhibitors reduce mortality in hypertension: a meta-analysis of randomized clinical trials of renin-angiotensin-aldosterone system inhibitors involving 158,998 patients. Eur Heart J. 2012; 33(16): 2088-97.
3. Curran MP, McCormack PL, Simpson D. Perindopril: a review of its use in patients with or at risk of developing coronary artery disease. Drugs. 2006; 66(2): 235-55.
4. Bertrand ME, Ferrari R, Remme WJ et al. Clinical synergy of perindopril and calcium-channel blocker in the prevention of cardiac events and mortality in patients with coronary artery disease. Post hoc analysis of the EUROPA study. Am Heart J. 2010; 159(5): 795-802.
5. Haria M, Wagstaff AJ. Amlodipine. A reappraisal of its pharmacological properties and therapeutic use in cardiovascular disease. Drugs. 1995; 50(3): 560-86.
6. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group; The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002; 288(23): 2981-97.
7. Dahlöf B, Sever PS, Poulter NR et al. 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-BPLA): a multicentre randomised controlled trial. Lancet. 2005; 366(9489): 895-906.
8. Weder AB. The Avoiding Cardiovascular events through COMbination therapy in Patients Living with Systolic Hypertension (ACCOMPLISH) trial: a comparison of first-line combination therapies. Expert Opin Pharmacother. 2005; 6(2): 275-81.
9. Nissen SE, Tuzcu EM, Libby P et al. Effect of antihypertensive agents on cardiovascular events in patients with coronary disease and normal blood pressure: the CAMELOT study: a randomized controlled trial. JAMA. 2004; 292(18): 2217-25.
10. Williams B, Lacy PS, Thom SM 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(9): 1213-25.
11. Roush GC, Sica DA. Diuretics for Hypertension: A Review and Update. American Journal of Hypertension. 2016; 29(10): 1130-7.
12. McNally RJ, Morselli F, Farukh B et al. A review of the prescribing trend of thiazide-type and thiazide-like diuretics in hypertension: A UK perspective. Br J Clin Pharmacol. 2019; 85(12): 2707-13.
13. Robinson DM, Wellington K. Indapamide sustained release: a review of its use in the treatment of hypertension. Drugs. 2006; 66(2): 257-71.
14. PATS Collaborating Group. Post-stroke antihypertensive treatment study. A preliminary result. Chin Med J (Engl). 1995; 108(9): 710-7.
15. Marazzi G, Pelliccia F, Campolongo G et al. Greater cardiovascular risk reduction with once-daily fixed combination of three antihypertensive agents and statin versus free-drug combination: The ALL-IN-ONE trial. Int J Cardiol. 2016; 222: 885-7.
16. Nedogoda SV, Stojanov VJ. Single-Pill Combination of Perindopril/Indapamide/Amlodipine in Patients with Uncontrolled Hypertension: A Randomized Controlled Trial. Cardiol Ther. 2017; 6(1): 91-104.
17. Mourad JJ, Amodeo C, de Champvallins M et al. Blood pressure-lowering efficacy and safety of perindopril/indapamide/amlodipine single-pill combination in patients with uncontrolled essential hypertension: a multicenter, randomized, double-blind, controlled trial. J Hypertens. 2017; 35(7): 1481-95.
18. Brguljan J, Chazova IE, Gaciong Z et al. Precious trial confirms safety and efficacy of guideline’s single-pill combination strategy. J Hypertens. 2021; 39: e415.
19. Shelest BO, Hryhorian OV, Sarkis-Ivanova VV et al. Therapeutic strategy in patients with long-lasting essential hypertension with comorbid type 2 diabetes mellitus and obesity. Arterial Hypertension. 2021; 25(1): 39-46.
20. Snyman JR, Bortolotto LA, Degli Esposti L et al. A real-world analysis of outcomes and healthcare costs of patients on perindopril/indapamide/amlodipine single-pill vs. multiple-pill combination in Italy. J Hypertens. 2024; 42(1): 136-42.