Management of hypertension with fixed-dose triple-combination treatments

Abstract

The objective of this review is to evaluate the role of fixed-dose triple-combination therapy for the management of hypertension. An assessment of clinical trials showed that half the patients with hypertension have uncontrolled blood pressure (BP), with underlying factors including therapeutic inertia and poor patient adherence. Many patients will require three antihypertensive agents to achieve BP goals, and current guidelines recommend combining drugs with complementary mechanisms of action. Three single-pill triple-combination treatments are available and each includes an agent affecting the renin-angiotensin-aldosterone pathway (either a direct renin inhibitor or an angiotensin II receptor blocker) in combination with a calcium channel blocker and diuretic. These triple-combination therapies consistently demonstrated significantly greater BP reduction relative to the component dual combinations, with BP reductions documented across a range of patient populations. Triple-combination treatments were well tolerated in all clinical trials reviewed. 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 BP control.

Adherence to triple‐component antihypertensive regimens is higher with single‐pill than equivalent two‐pill regimens: A randomized controlled trial

“…Previous studies on the adherence benefit of SPC were done mainly with dual‐component SPC. However, many patients with HTN need triple combination therapy, 16 and this study provides convincing evidence that triple‐component SPC has superiority over an equivalent two‐pill regimen as well.…”

Angiotensin receptor blockers: Focus on cardiac and renal injury

“…Similarly, combination of ARB with statins can exert more beneficial effects on vascular remodeling thereby preventing vascular diseases such as atherosclerosis. The use of single-pill, triple-combination antihypertensive therapy (renin inhibitor/ARB plus calcium channel blocker plus diuretic) has been shown to be an effective, well-tolerated, and convenient treatment strategy that can help patients achieve BP control [37]. Aliskiren addon therapy may be beneficial for suppression of renal deterioration and pathological cardiac remodeling through an improvement that is effected in ambulatory BP and HR profiles [38].…”

What does fixed-dose triple-combination treatment for arterial hypertension bring us?

“…Pedesetak posto hipertoničara treba dva ili više antihipertenziva, a barem 25 % njih treba trojnu kombinaciju lijekova kako bi se postigle ciljne vrijednosti AT-a 3, 11 . ALLHAT, INVEST, SCOPE, HOT, MDRD, AASK primjeri su kliničkih studija koje dokazuju da je u veći-ne bolesnika nužna kombinirana antihipertenzivna terapija 3 . Slijedom toga, smjernice Europskoga društva za hipertenziju (ESH) i Europskoga kardiološkoga društva (ESC) za liječenje AH-a godine 2007. prvi put su uvrstile kombinaciju antihipertenziva u prvu crtu liječenja pri izoliranoj sistoličkoj AH, kod brzo progresivne AH, u bolesnika s AT-om <140/90 mmHg u svrhu prevencije oštećenja ciljnih organa (dijabetičari, kronična parenhimna bubrežna bolest) 11, 12 .…”

“…Na nju utječe niz čimbenika: broj tableta koje se uzimaju tijekom dana, zaboravljivost, pojava nuspojava, suradnja s liječnikom. Prema nekim metaanalizama mnogo je bolja adherentnost u liječenju postignuta uzimanjem fiksnih doza antihipertenziva s obzirom na slobodne kombinacije pojedinih antihipertenziva 3 . Bolja adherentnost dovodi do bolje kontrole AT-a, smanjenja morbiditeta od KV-a i CV-a, smanjuje se stopa bolovanja i hospitalizacija zbog KV i CV bolesti, a time se smanjuje i ekonomski trošak 3 .…”