Fixed Low-Dose Triple Combination Antihypertensive Medication vs Usual Care for Blood Pressure Control in Patients With Mild to Moderate Hypertension in Sri Lanka

Webster, Ruth; Salam, Abdul; Silva, H. Asita de; Selak, Vanessa; Stepien, Sandrine; Rajapakse, Senaka; Amarasekara, Stanley; Amarasena, Naomali; Billot, Laurent; Silva, Arjuna P. De; Fernando, Mervyn; Guggilla, Rama; Jan, Stephen; Jayawardena, Jayanthimala; Maulik, Pallab K.; Mendis, Sepalika; Mendis, Suresh; Munasinghe, Janake; Naik, Nitish; Prabhakaran, Dorairaj; Ranasinghe, Gayan; Thom, Simon; Tisserra, Nirmali; Senaratne, Vajira; Wijekoon, S.; Wijeyasingam, Santharaj; Rodgers, Anthony; Patel, Anushka

doi:10.1001/jama.2018.10359

Cited by 139 publications

(113 citation statements)

References 40 publications

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“…A 2018 trial of a fixed low-dose triple-combination antihypertensive drug tested in urban Sri Lanka, consisting of amlodipine, telmisartan, and chlorthalidone, showed substantial improvement in control of blood pressure compared with usual care at 6 months, and no difference in adverse events. 20 Another trial from 2016 showed that lowering LDL cholesterol with a high-potency statin was effective even among individuals only at intermediate risk of cardiovascular events. 21 Efforts to improve universal health coverage must directly address how these therapies can be delivered even more effectively.…”

Section: Discussionmentioning

confidence: 99%

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Stanaway¹,

Afshin²,

Gakidou³

et al. 2018

The Lancet

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3,738

1,899

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SummaryBackgroundThe Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk–outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk–outcome pairs, and new data on risk exposure levels and risk–outcome associations.MethodsWe used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk–outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017.FindingsIn 2017, 34·1 million (95% uncertainty interval [UI] 33·3–35·0) deaths and 1·21 billion (1·14–1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6–62·4) of deaths and 48·3% (46·3–50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39–11·5) deaths and 218 million (198–237) DALYs, followed by smoking (7·10 million [6·83–7·37] deaths and 182 million [173–193] DALYs), high fasting plasma glucose (6·53 million [5·23–8·23] deaths and 171 million [144–201] DALYs), high body-mass index (BMI; 4·72 million [2·99–6·70] deaths and 148 million [98·6–202] DALYs), and short gestation for birthweight (1·43 million [1·36–1·51] deaths and 139 million [131–147] DALYs). I...

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Section: Discussionmentioning

confidence: 99%

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Stanaway¹,

Afshin²,

Gakidou³

et al. 2018

The Lancet

Self Cite

3,738

1,899

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“…SPCs were exclusively used in only 34% of patients, while in the remaining 66% of patients the combinations used were either free (39%) or comprised both SPC and free components (27%). The use of SPCs, as compared to their free-drug counterparts, has been shown to be associated with a significant higher adherence rate to treatment [ 19 – 22 ] and lower health-care costs [ 20 ], while a non-significant reduction in blood pressure [ 19 ] but a significant improved blood pressure control rate [ 21 , 23 ] were reported. High adherence to antihypertensive treatment has been shown to be related to lower cardiovascular events [ 24 – 27 ].…”

Section: Discussionmentioning

confidence: 99%

Cross-sectional survey evaluating blood pressure control ACHIEVEment in hypertensive patients treated with multiple anti-hypertensive agents in Belgium and Luxembourg

et al. 2018

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ObjectiveThis study evaluates the actual blood pressure control rate and its estimation by general practitioners, the use of single-pill or free combinations, and the attitude towards single-pill combinations in primary care.MethodsCross-sectional observational survey in primary care between January 2015 and September 2016 in Belgium and Luxembourg. The participating general practitioners enrolled hypertensive patients taking at least 2 antihypertensive molecules (as fixed or free associations).Results742 general practitioners included a total of 8,006 patients, with a mean age of 66 ± 12 years. Systolic blood pressure and diastolic blood pressure were respectively 141 ± 17 mmHg and 82 ± 10 mmHg (means ± SD). These patients had a blood pressure control rate of 45%, whereas it was estimated by general practitioners to be 60%. General practitioners with 11–25 years’ experience performed better than general practitioners with 36–51 years’ experience in the evaluation of blood pressure control. Combinations used were free in 39%, single-pill in 34% and mixed in 27% of the patients. Patients receiving single-pill combinations were younger than those treated with free combinations (63 ± 12 vs. 68 ± 12 years, p < 0.001), with fewer comorbidities (39 vs. 55%, p < 0.001). In patients treated solely with free pill associations, 66% of patient cases, general practitioners were willing to switch to a single-pill combination. The main reasons were improved adherence (76%) and better blood pressure control (64%).ConclusionIn patients requiring at least two antihypertensive drugs, blood pressure control rate remains low and is overestimated by general practitioners. Free combinations remain largely used although many general practitioners seem willing to shift to single-pill combinations. Treatment simplification could improve adherence and blood pressure control rate, which has been shown to lead to reduced morbidity and mortality.

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“…Fixed‐dose triplet combination therapy was not included in the present study, as it has only been in use since 2017. Recently, antihypertensive fixed‐dose triple combination therapy was shown to be well tolerated in Japan; and in Sri Lanka, it was reported to result in an increased proportion of patients achieving their target blood pressure goal versus usual care . It might be necessary to investigate fixed‐dose triplet combination therapy differences in hypertension treatment in future.…”

Section: Discussionmentioning

confidence: 99%

Treatment patterns of antihypertensive fixed‐dose combinations according to age and number of agents prescribed: Retrospective analysis using a Japanese claims database

Ishida

Nishigaki

et al. 2019

Geriatrics Gerontology Int

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Aim To determine the real‐world use of fixed‐dose combinations (FDC) of antihypertensive agents using data collected from a nationwide medical database of acute hospitals in Japan. Methods We carried out a retrospective analysis of data from the Medical Data Vision database for patients with hypertension who received an antihypertensive drug prescription between April 2014 and March 2015. The prescription rate of antihypertensive FDC were assessed by class, age and according to combinations. Results In total, data from 59 867 patients aged 70.0 ± 11.9 years (mean ± SD) were analyzed. Patients were prescribed 1.9 ± 1.0 oral antihypertensive agents (mean ± SD). Overall, 58.6% of patients were prescribed two or more antihypertensive agents, and the most frequently prescribed classes were calcium channel blockers (CCB) and angiotensin II receptor blockers (ARB). As the number of concomitant antihypertensive agents prescribed increased, the prescription rate of a CCB + an ARB FDC decreased, whereas the prescription rate of an ARB + a diuretic FDC increased. This trend was the same regardless of age. Of the 12 222 patients who were prescribed a CCB + an ARB, 26.0% received a FDC. In contrast, of the 922 patients prescribed an ARB + a thiazide diuretic, 80.6% received a FDC. Medium doses of both CCB and ARB agents, and low doses of diuretics were the most frequently prescribed for each class. Conclusions Our analyses show that the real‐world use of FDC varies depending on the combination of agent class and the number of prescriptions; the latter was similar regardless of age. Geriatr Gerontol Int 2019; 19: 1077–1083.

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Fixed Low-Dose Triple Combination Antihypertensive Medication vs Usual Care for Blood Pressure Control in Patients With Mild to Moderate Hypertension in Sri Lanka

Abstract: anzctr.org.au Identifier: ACTRN12612001120864; slctr.lk Identifier: SLCTR/2015/020.

Cited by 139 publications

References 40 publications

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Cross-sectional survey evaluating blood pressure control ACHIEVEment in hypertensive patients treated with multiple anti-hypertensive agents in Belgium and Luxembourg

Treatment patterns of antihypertensive fixed‐dose combinations according to age and number of agents prescribed: Retrospective analysis using a Japanese claims database

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