Personalised Single-Pill Combination Therapy in Hypertensive Patients: An Update of a Practical Treatment Platform

Abstract

Despite the improvements in the management of hypertension during the last three decades, it continues to be one of the leading causes of cardiovascular morbidity and mortality worldwide. Effective and sustained reductions in blood pressure (BP) reduce the incidence of myocardial infarction, stroke, congestive heart failure and cardiovascular death. However, the proportion of patients who achieve the recommended BP goal (< 140/90 mmHg) is persistently low, worldwide. Poor adherence to therapy, complex therapeutic regimens, clinical inertia, drug-related adverse events and multiple risk factors or comorbidities contribute to the disparity between the potential and actual BP control rate. Previously we published a practical therapeutic platform for the treatment of hypertension based on clinical evidence, guidelines, best practice and clinical experience. This platform provides a personalised treatment approach and can be used to improve BP control and simplify treatment. It uses long-acting, effective and well-tolerated angiotensin receptor blocker (ARB) olmesartan, in combination with a calcium channel blocker amlodipine, and/or a thiazide diuretic hydrochlorothiazide. These drugs were selected based on the availability in most European Countries of single-pill, fixed formulations in a wide range of doses for both dual- and triple-drug combinations. The platform approach could be applied to other ARBs or angiotensin-converting enzyme inhibitors available in single-pill, fixed-dose combinations. Here, we present an update, which takes into account the results of the recently published studies and extends the applicability of the platform to common conditions that are often neglected or poorly considered in clinical practice guidelines.Electronic supplementary materialThe online version of this article (doi:10.1007/s40292-017-0239-7) contains supplementary material, which is available to authorized users.

Is early and fast blood pressure control important in hypertension management?

“…The use of fixed-dose combination therapies represents a very attractive strategy for improving BP control and represents today one of the key elements for a successful large-scale hypertension program with the aim of obtaining BP control in the large majority of hypertensive patients, as well as higher levels of adherence and persistence of the treatment [53]. In this view, a platform approach has been proposed to help physicians in making the most appropriate choice, with therapies founded on single-pill fixed dose combination of two or three drugs, on the basis of grade of hypertension, concomitant risk factors and organ damage and comorbidities [54,55].…”

Hypertension, medications, and risk of severe COVID‐19: A Massachusetts community‐based observational study

“…This hypothesis evolved from the observation that thiazide has been suggested to decrease ACE2 expression in animals 16 and some country level usage data appeared to correlate with COVID-19 death rates. [17][18][19] During our study period, evidence emerged suggesting the virus attacks blood vessels with reports of high prevalence of thrombotic events in COVID-19 patients 20 so we additionally investigated whether pre-infection anticoagulant medication modified the risk of severe COVID-19.…”

Blood Pressure Target Achievement Under Monotheraphy: A Real-Life Appraisal

“…Although antihypertensive treatment should be individualized depending on characteristics of single patient [45,46], and short follow-up of patients treated with monotherapy may contribute to implement the attained BP control rate, our findings highlight the need to readdress clinicians' approach to antihypertensive therapy in favour of a more extended use of combination therapies with respect to monotherapies.…”