Single-pill, triple-combination antihypertensive therapy – from the cardiologist point of view Review article
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Published:
Jan 17, 2017
Keywords:
combined therapy, perindopril, amlodipine, indapamide
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Abstract
An assessment of clinical trials showed that half of patients with hypertension have uncontrolled blood pressure, with underlying factors including poor patient adherence. Many patients will require three antihypertensive agents to achieve therapeutic goals, and current guidelines recommend combining drugs with complementary mechanisms of action. A single-pill triple-combination treatments is available that includes an agent affecting the renin–angiotensin– aldosterone pathway in combination with a calcium channel blocker and diuretic. The use of single-pill, triple- combination antihypertensive therapy has been shown to be an effective, well tolerated, and convenient treatment strategy that can help patients achieve blood pressure control.
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Postuła , M. (2017). Single-pill, triple-combination antihypertensive therapy – from the cardiologist point of view. Cardiology in Practice, 10(4), 3-9. Retrieved from https://journalsmededu.pl/index.php/kwp/article/view/1265
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Copyright: © Medical Education sp. z o.o. This is an Open Access article distributed under the terms of the Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). License (https://creativecommons.org/licenses/by-nc/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
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References
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10. Berlowitz D.R., Ash A.S., Hickey E.C. et al.: Inadequate management of blood pressure in a hypertensive population. N. Engl. J. Med. 1998; 339: 1957-1963.
11. Veterans Administration Cooperative Study Group on Antihypertensive Agents (VACSG): Effects of treatment on morbidity in hypertension. Results in patients with diastolic blood pressures averaging 115 through 129 mm Hg. JAMA 1967; 202: 1028-1034.
12. Toth K.: Antihypertensive efficacy of triple combination perindopril/ indapamide plus amlodipine in high-risk hypertensives: results of the PIANIST study (Perindopril-Indapamide plus AmlodipiNe in high rISk hyperTensive patients). Am. J. Cardiovasc. Drugs 2014; 14(2): 137-145.
13. Páll D., Szántó I., Szabó Z.: Triple combination therapy in hypertension: the antihypertensive efficacy of treatment with perindopril, amlodipine, and indapamide SR. Clin. Drug Investig. 2014; 34: 701-708.
14. Chalmers J., Arima H., Woodward M. et al.: Effects of combination of perindopril, indapamide, and calcium channel blockers in patients with type 2 diabetes mellitus: results from the action in diabetes and vascular disease: preterax and diamicron controlled evaluation (ADVANCE) trial. Hypertension 2014; 63(2): 259-264.
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16. Patel A., MacMahon S., Chalmers J. et al.: 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: 829-840.
17. Zoungas S., Chalmers J., Neal B. et al.; ADVANCE-ON Collaborative Group: Follow-up of blood-pressure lowering and glucose control in type 2 diabetes. N. Engl. J. Med. 2014; 371: 1392-1406.
18. 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: 1887-1898.
19. 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-BPLA): a multicenter randomised controlled trial. Lancet 2005; 366: 895-906.
20. Jamerson K., Weber M.A., Bakris G.L. et al.; ACCOMPLISH Trial Investigators: Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N. Engl. J. Med. 2008; 359: 2417-2428.
21. Mancia G., Fagard R., Narkiewicz K. et al.: 2013 ESH/ESC 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). Eur. Heart J. 2013; 34: 2159-2219.
22. Bramley T.J., Gerbino P.P., Nightengale B.S. et al.: Relationship of blood pressure control to adherence with antihypertensive monotherapy in 13 managed care organizations. J. Manag. Care Pharm. 2006; 12: 239-245.
23. Fung V., Huang J., Brand R. et al.: Hypertension treatment in a medicare population: adherence and systolic blood pressure control. Clin. Ther. 2007; 29: 972-984.
24. Bailey J.E., Wan J.Y., Tang J. et al.: Antihypertensive medication adherence, ambulatory visits, and risk of stroke and death. J. Gen. Intern. Med. 2010; 25: 495-503.
25. Pittman D.G., Tao Z., Chen W. et al.: Antihypertensive medication adherence and subsequent healthcare utilization and costs. Am. J. Manag. Care 2010; 16: 568-576.
26. Dragomir A., Cote R., Roy L. et al.: Impact of adherence to antihypertensive agents on clinical outcomes and hospitalization costs. Med. Care 2010; 48: 418-425.
27. van Wijk B.L., Klungel O.H., Heerdink E.R. et al.: Rate and determinants of 10-year persistence with antihypertensive drugs. J. Hypertens. 2005; 23: 2101-2107.
28. Perreault S., Lamarre D., Blais L. et al.: Persistence with treatment in newly treated middle-aged patients with essential hypertension. Ann. Pharmacother. 2005; 39: 1401-1408.
29. Panjabi S., Lacey M., Bancro T. et al.: Treatment adherence, clinical outcomes, and economics of triple-drug therapy in hypertensive patients. J. Am. Soc. Hypertens. 2013; 7: 46-60.
30. Yang W., Chang J., Kahler K.H. et al.: Evaluation of compliance and health care utilization in patients treated with single pill vs. free combination antihypertensives. Curr. Med. Res. Opin. 2010; 26: 2065-2076.
31. Gupta A.K., Arshad S., Poulter N.R.: Compliance, safety, and effectiveness of fixed-dose combinations of antihypertensive agents: a meta-analysis. Hypertension 2010; 55: 399-407.
32. Cushman W.C., Ford C.E., Cutler J.A. et al.: Success and predictors of blood pressure control in diverse North American settings: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). J. Clin. Hypertens. 2002; 4: 393-404.
33. UK Prospective Diabetes Study Group: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br. Med. J. 1998; 317: 703-713.
34. Estacio R.O., Jeffers B.W., Gifford N. et al.: Effect of blood pressure control on diabetic microvascular complications in patients with hypertension and type 2 diabetes. Diabetes Care 2000; 23: B54-64.
35. Hebert L.A., Kusek J.W., Greene T. et al.: Effects of blood pressure control on progressive renal disease in blacks and whites [Modification of Diet in Renal Disease Study Group]. Hypertension 1997; 30: 428-435.
36. Hansson L., Zanchetti A., Carruthers S.G. et al.: Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 1998; 351: 1755-1762.
37. Wright J.T.J., Agodoa L., Contreras G. et al.: Successful blood pressure control in the African American Study of Kidney Disease and Hypertension. Arch. Intern. Med. 2002; 162: 1636-1643.
38. Jamerson K., Weber M.A., Bakris G.L. et al.; the ACCOMPLISH Trial Investigators: Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N. Engl. J. Med. 2008; 359: 2417-2428.
39. 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: 885-887.
2. Ettehad D., Emdin C.A., Kiran A. et al.: Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet 2016; 387: 957-967.
3. Kjeldsen S.E., Lund-Johansen P., Nilsson P.M., Mancia G.: Unattended blood pressure measurements in the systolic blood pressure intervention trial: implications for entry and achieved blood pressure values compared with other trials. Hypertension 2016; 67: 808-812.
4. Wright J.T. Jr., Williamson J.D., Whelton P.K. et al.: A randomized trial of intensive versus standard blood-pressure control. N. Engl. J. Med. 2015; 373: 2103-2116.
5. Neutel J.M.: Prescribing patterns in hypertension: the emerging role of fixed-dose combinations for attaining BP goals in hypertensive patients. Curr. Med. Res. Opin. 2008; 24(8): 2389-2401.
6. Xie X., Atkins E., Lv J. et al.: Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Lancet 2016; 387(10017): 435-443.
7. Wald D.S., Law M., Morris J.K. et al.: Combination therapy versus monotherapy in reducing blood pressure: meta-analysis on 11,000 participants from 42 trials. Am. J. Med. 2009; 122(3): 290-300.
8. Berlowitz D.R., Ash A.S., Hickey E.C. et al.: Hypertension management in patients with diabetes: the need for more aggressive therapy. Diabetes Care 2003; 26: 355-359.
9. Psaty B.M., Manolio T.A., Smith N.L. et al.: Time trends in high blood pressure control and the use of antihypertensive medications in older adults: the Cardiovascular Health Study. Arch. Intern. Med. 2002; 162: 2325-2332.
10. Berlowitz D.R., Ash A.S., Hickey E.C. et al.: Inadequate management of blood pressure in a hypertensive population. N. Engl. J. Med. 1998; 339: 1957-1963.
11. Veterans Administration Cooperative Study Group on Antihypertensive Agents (VACSG): Effects of treatment on morbidity in hypertension. Results in patients with diastolic blood pressures averaging 115 through 129 mm Hg. JAMA 1967; 202: 1028-1034.
12. Toth K.: Antihypertensive efficacy of triple combination perindopril/ indapamide plus amlodipine in high-risk hypertensives: results of the PIANIST study (Perindopril-Indapamide plus AmlodipiNe in high rISk hyperTensive patients). Am. J. Cardiovasc. Drugs 2014; 14(2): 137-145.
13. Páll D., Szántó I., Szabó Z.: Triple combination therapy in hypertension: the antihypertensive efficacy of treatment with perindopril, amlodipine, and indapamide SR. Clin. Drug Investig. 2014; 34: 701-708.
14. Chalmers J., Arima H., Woodward M. et al.: Effects of combination of perindopril, indapamide, and calcium channel blockers in patients with type 2 diabetes mellitus: results from the action in diabetes and vascular disease: preterax and diamicron controlled evaluation (ADVANCE) trial. Hypertension 2014; 63(2): 259-264.
15. Fox K.M.; EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease Investigators: Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet 2003; 362: 782-788.
16. Patel A., MacMahon S., Chalmers J. et al.: 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: 829-840.
17. Zoungas S., Chalmers J., Neal B. et al.; ADVANCE-ON Collaborative Group: Follow-up of blood-pressure lowering and glucose control in type 2 diabetes. N. Engl. J. Med. 2014; 371: 1392-1406.
18. 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: 1887-1898.
19. 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-BPLA): a multicenter randomised controlled trial. Lancet 2005; 366: 895-906.
20. Jamerson K., Weber M.A., Bakris G.L. et al.; ACCOMPLISH Trial Investigators: Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N. Engl. J. Med. 2008; 359: 2417-2428.
21. Mancia G., Fagard R., Narkiewicz K. et al.: 2013 ESH/ESC 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). Eur. Heart J. 2013; 34: 2159-2219.
22. Bramley T.J., Gerbino P.P., Nightengale B.S. et al.: Relationship of blood pressure control to adherence with antihypertensive monotherapy in 13 managed care organizations. J. Manag. Care Pharm. 2006; 12: 239-245.
23. Fung V., Huang J., Brand R. et al.: Hypertension treatment in a medicare population: adherence and systolic blood pressure control. Clin. Ther. 2007; 29: 972-984.
24. Bailey J.E., Wan J.Y., Tang J. et al.: Antihypertensive medication adherence, ambulatory visits, and risk of stroke and death. J. Gen. Intern. Med. 2010; 25: 495-503.
25. Pittman D.G., Tao Z., Chen W. et al.: Antihypertensive medication adherence and subsequent healthcare utilization and costs. Am. J. Manag. Care 2010; 16: 568-576.
26. Dragomir A., Cote R., Roy L. et al.: Impact of adherence to antihypertensive agents on clinical outcomes and hospitalization costs. Med. Care 2010; 48: 418-425.
27. van Wijk B.L., Klungel O.H., Heerdink E.R. et al.: Rate and determinants of 10-year persistence with antihypertensive drugs. J. Hypertens. 2005; 23: 2101-2107.
28. Perreault S., Lamarre D., Blais L. et al.: Persistence with treatment in newly treated middle-aged patients with essential hypertension. Ann. Pharmacother. 2005; 39: 1401-1408.
29. Panjabi S., Lacey M., Bancro T. et al.: Treatment adherence, clinical outcomes, and economics of triple-drug therapy in hypertensive patients. J. Am. Soc. Hypertens. 2013; 7: 46-60.
30. Yang W., Chang J., Kahler K.H. et al.: Evaluation of compliance and health care utilization in patients treated with single pill vs. free combination antihypertensives. Curr. Med. Res. Opin. 2010; 26: 2065-2076.
31. Gupta A.K., Arshad S., Poulter N.R.: Compliance, safety, and effectiveness of fixed-dose combinations of antihypertensive agents: a meta-analysis. Hypertension 2010; 55: 399-407.
32. Cushman W.C., Ford C.E., Cutler J.A. et al.: Success and predictors of blood pressure control in diverse North American settings: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). J. Clin. Hypertens. 2002; 4: 393-404.
33. UK Prospective Diabetes Study Group: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. Br. Med. J. 1998; 317: 703-713.
34. Estacio R.O., Jeffers B.W., Gifford N. et al.: Effect of blood pressure control on diabetic microvascular complications in patients with hypertension and type 2 diabetes. Diabetes Care 2000; 23: B54-64.
35. Hebert L.A., Kusek J.W., Greene T. et al.: Effects of blood pressure control on progressive renal disease in blacks and whites [Modification of Diet in Renal Disease Study Group]. Hypertension 1997; 30: 428-435.
36. Hansson L., Zanchetti A., Carruthers S.G. et al.: Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet 1998; 351: 1755-1762.
37. Wright J.T.J., Agodoa L., Contreras G. et al.: Successful blood pressure control in the African American Study of Kidney Disease and Hypertension. Arch. Intern. Med. 2002; 162: 1636-1643.
38. Jamerson K., Weber M.A., Bakris G.L. et al.; the ACCOMPLISH Trial Investigators: Benazepril plus amlodipine or hydrochlorothiazide for hypertension in high-risk patients. N. Engl. J. Med. 2008; 359: 2417-2428.
39. 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: 885-887.