Starting Antihypertensive Drug Treatment With Combination Therapy

Zhang, Zhenyu; Yu, Yu-Ling; Asayama, Kei; Hansen, Tine W.; Maestre, Gladys E.; Staessen, Jan A.

doi:10.1161/hypertensionaha.120.12858

Cited by 12 publications

(5 citation statements)

References 87 publications

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“…Till now, one point of discussion was that none of the trials of SPCs had a cardiovascular end point. 22 The results of our study strongly support the recommendations of national and international guidelines to treat arterial hypertension with a combination therapy given in 1 single pill whenever possible. 23 Implementation of the given clinical evidence regarding SPC into daily practice seems to be a challenge.…”

Section: Discussionsupporting

confidence: 83%

Improved Persistence to Medication, Decreased Cardiovascular Events and Reduced All-Cause Mortality in Hypertensive Patients With Use of Single-Pill Combinations: Results From the START-Study

et al. 2023

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Background: Single-pill combination improves adherence and persistence to medication in hypertension. It remains unclear whether this also reduces cardiovascular outcomes and all-cause mortality. We analyzed whether single-pill combinations are superior to identical multiple pills on persistence to medication, cardiovascular outcomes, and all-cause mortality. Methods: This was a retrospective claims data (German AOK PLUS) analysis. Data from hypertensive patients ≥18 years treated with renin-angiotensin system combinations given as single pill or identical multipills covering the years 2012 to 2018 were analyzed and followed up to at least 1 year. After 1:1 propensity score matching, persistence to medication, cardiovascular events, and all-cause mortality were compared using non-parametric tests. Results were reported as incidence rate ratios and hazard ratios. Results: After propensity score matching data from 57 998 patients were analyzed: 10 801 patients received valsartan/amlodipine, 1026 candesartan/amlodipine, 15 349 ramipril/amlodipine, and 1823 amlodipine/valsartan/hydrochlorothiazide as single pill or identical multipill. No relevant differences in patient characteristics were observed within the 4 groups. In all groups, a significant lower all-cause mortality a significant a higher persistence to medication, a significant lower event rate in 15 out of 20 comparisons, and a tendency in the remaining 5 comparisons was observed under single pills compared with multipill combinations. Conclusions: Antihypertensive combination therapy reduces all-cause mortality and cardiovascular when provided as single pill compared to identical drugs as multipills. This strongly supports the ESC/ESH and ISH guidelines recommending the use of a single-pill concept and should be more rigorously implemented into daily clinical practice.

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Section: Discussionsupporting

confidence: 83%

Improved Persistence to Medication, Decreased Cardiovascular Events and Reduced All-Cause Mortality in Hypertensive Patients With Use of Single-Pill Combinations: Results From the START-Study

et al. 2023

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“…Sebagian besar sumber informasi penggunaan SPC berasal dari studi observasional dengan desain retrospektif jangka pendek. 21 KEAMANAN Salah satu tujuan penggunaan SPC adalah meminimalisir efek samping obat karena dosis tinggi pada monoterapi. Penggunaan SPC dapat mengurangi dosis obat individual dengan mengombinasikannya dengan obat lainnya.…”

Section: Luaran Kardiovaskularunclassified

Single Pill Combination sebagai Lini Pertama Terapi Hipertensi dan Proteksi Kardiovaskular

Hengky

Rusiawati²

2023

Cermin Dunia Kedokteran

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Sebagian besar pasien hipertensi membutuhkan 2 hingga 3 obat untuk dapat mencapai target terapeutik yang disarankan oleh berbagai organisasi ahli. Penggunaan single pill combination (SPC) merupakan salah satu solusi untuk meningkatkan kepatuhan pasien demi kontrol hipertensi yang adekuat. Efek anti-hipertensi kombinasi 2 obat dari kelas mekanisme kerja yang berbeda 2-5 kali lipat lebih tinggi dibandingkan monoterapi, serta dosis dapat dikurangi untuk menghindari efek samping obat. Berbagai studi kohort retrospektif menunjukkan bahwa penggunaan SPC dapat meningkatkan kepatuhan minum obat, menurunkan angka kematian dan rawat inap akibat penyakit kardiovaskular. Penggunaan SPC perlu mempertimbangkan fleksibilitas, akses, serta kemampuan finansial pasien. Patient with hypertension mostly need 2 or 3 medications to achieve the recommended therapeutic target. The use of single pill combination (SPC) is one of the solution to improve adherence and achieve adequate control of hypertension. The anti-hypertensive effects of dual combination from different classes drugs can achieve 2 to 5 times higher than monotherapy, and dose reduction of each drug in combination therapy might avoid adverse effects. Many retrospective cohort studies have found that the utilization of SPC improved patients’ adherence and decrease mortality and hospital admission rate due to cardiovascular events. SPC usage needs to consider flexibility, access, and patient’s financial status.

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“…Africa has the highest prevalence of hypertension in the world as 46% of adults aged 25 years and above have a raised blood pressure (2,4), and a study in Southern Nigeria found a prevalence of 40.8% (5). The primary goal of antihypertensive therapy is to prevent morbidity and mortality associated with hypertension (6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Patient-reported adverse events associated with use of anti-hypertensive drugs in a tertiary hospital in southern Nigeria

Chibuike Eze Nwafor,

Marvis Somtochukwu Muo

2024

World J. Bio. Pharm. Health Sci.

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Background Hypertension is a leading cause of cardiovascular morbidity and mortality worldwide especially in sub-Saharan Africa. Adverse events with use of antihypertensive medications deter patients’ adherence. This study is aimed at evaluating the adverse events and comorbidities associated with the use of antihypertensive as seen in a tertiary hospital in southern Nigeria. Method This retrospective cross-sectional study was conducted at a tertiary healthcare hospital in southern Nigeria. Data was collected for a period of six months from 194 patients who attended cardiac clinic with demographic details, blood pressure values, antihypertensive drugs in use, level of medication adherence, adverse events, and co-morbidities. Result Antihypertensive medications were prescribed according to their classes. Telmisartan (ARB) being the most prescribed one. Fixed dose single pill combination was more preferred. Adverse events such as dry cough, peripheral neuropathy, dizziness, peripheral edema, and erectile dysfunction were recorded. Major comorbidities are diabetes mellitus, dyspepsia and hyperlipidemia. Findings revealed gender disparities with males experiencing erectile dysfunction and more. Conclusion This analysis pinpoints the need for prompt identification of comorbidities and side effects when treating hypertension. Patients’ compliance to treatment and therapy effectiveness is largely dependent on the provision of patient-specific treatment plan.

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Starting Antihypertensive Drug Treatment With Combination Therapy

Abstract: Supplemental Digital Content is available in the text.

Cited by 12 publications

References 87 publications

Improved Persistence to Medication, Decreased Cardiovascular Events and Reduced All-Cause Mortality in Hypertensive Patients With Use of Single-Pill Combinations: Results From the START-Study

Improved Persistence to Medication, Decreased Cardiovascular Events and Reduced All-Cause Mortality in Hypertensive Patients With Use of Single-Pill Combinations: Results From the START-Study

Single Pill Combination sebagai Lini Pertama Terapi Hipertensi dan Proteksi Kardiovaskular

Patient-reported adverse events associated with use of anti-hypertensive drugs in a tertiary hospital in southern Nigeria

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