The Number of Pills, Rather Than the Type of Renin–Angiotensin System Inhibitor, Predicts Ambulatory Blood Pressure Control in Essential Hypertensives on Triple Therapy: A Real-Life Cross-Sectional Study

Abstract

Introduction: We evaluated the prevalence and predictors of ambulatory blood pressure (BP) control in patients taking a triple antihypertensive therapy (renin-angiotensin system inhibitor ? calcium channel blocker ? thiazide/thiazide-like diuretic, in either free or fixed-dose combinations) containing an angiotensin-converting enzyme inhibitor (ACEi) or an angiotensin receptor blocker (ARB). Methods: We performed an observational cross-sectional study on 520 consecutive patients with essential hypertension taking a stable triple therapy in whom 24-h ambulatory BP was evaluated. Both number of pills and antihypertensive treatment intensity (ATI), as possible pharmacological predictors of ambulatory BP control, were taken into account. Results: A total of 189 (36.3%) patients were taking triple therapy with ACEi and 331 (63.7%) patients were taking triple therapy with ARB. Mean age was 62.7 ± 12.2 years. Patients on triple therapy with ACEi had a significantly lower ATI and took fewer antihypertensive pills than patients on triple therapy with ARB (22.2% of patients took a single-pill triple fixed-dose combination). Patients taking triple therapy with ACEi had higher prevalence of both 24-h (54.8% vs 44.0%; p = 0.019) and daytime BP control (61.8% vs 49.2%; p = 0.006) than patients taking triple therapy with ARB, even after adjusting for age, sex, body mass index, smoking habit, type 2 diabetes mellitus, estimated glomerular filtration rate, and ATI [OR 1.5 (95% CI 1.1-2.2) and OR 1.6 (95% CI 1.1-2.4), respectively]. However, these independent associations with ambulatory BP control were lost when the number of antihypertensive pills was included in the model. Conclusion:The higher prevalence of ambulatory BP control found in patients taking a triple therapy with ACEi was affected by the lower number of antihypertensive pills taken, which was also the key predictor of ambulatory BP control in our study. This confirms the importance of fixed-dose combinations in the management of essential hypertension.

Molecular Therapies in Cardiovascular Diseases: Small Interfering RNA in Atherosclerosis, Heart Failure, and Hypertension

“…Hypertension affects nearly 1.3 billion adults worldwide, and it is one of the most common risk factors for death [ 57 ]. Despite the availability of several new drugs and fixed-dose combinations [ 58 , 59 ], blood pressure (BP) control is achieved in less than a quarter of hypertensives worldwide [ 60 ]. One of the main problems is the adherence to drug therapy due to multi-pill regimens, too often not simplified by the use of single-pill combinations, that should be taken each day for decades.…”

Single-pill fixed-dose drug combinations to reduce blood pressure: the right pill for the right patient

“…These data confirm the important role played by FDC of two or more drugs in improving adherence, by reducing the number of pills needed. 38 Combination therapy also offers advantages concerning the possible side effects of antihypertensive drugs. Malleolar edema is the most common side effect reported during the chronic treatment with CCB, 39 while hypokalemia can be induced by diuretics.…”

“…These data confirm the important role played by FDC of two or more drugs in improving adherence, by reducing the number of pills needed. 38 …”

A real-world analysis of outcomes and healthcare costs of patients on perindopril/indapamide/amlodipine single-pill vs. multiple-pill combination in Italy

“…Poor adherence to treatment has been identified as a contributing factor to poor BP control [ 5 ]. Similarly, a lower number of pills, rather than the type of intervention, has been shown to increase the prevalence of BP control [ 9 ]. SPCs could offer an opportunity to improve adherence by simplifying treatment, as demonstrated in elderly patients in Italy, who were more adherent to single-pill therapy than a fixed combination therapy of multiple drugs [ 10 ].…”