Long-term persistence with single-pill, fixed-dose combination therapy versus two pills of amlodipine and perindopril for hypertension: Australian experience

Simons, Leon A.; Chung, Eric; Ortiz, Michael

doi:10.1080/03007995.2017.1367275

Cited by 35 publications

(24 citation statements)

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“…Patients initiated with a SPC had a significantly higher proportion of total follow-up days covered with medications and a lower frequency of the primary outcome [ 27 ]. Recently also, it has been shown, in a large group of Australian hypertensive patients, that treatment with SPCs resulted in a lower mortality compared to patients taking the same antihypertensive agents in separate pills [ 28 ]. We found that, in accordance with the 2013 ESH-ESC guidelines [ 1 ], many GPs consider switching from free combinations to SPCs, with the hope of improving therapeutic compliance and blood pressure control.…”

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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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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“…All 29 studies reported on adherence and/or persistence in patients taking SPC therapy for hypertension. Four studies were RCTs (14%) [35,37,38,46]; the remainder (n ¼ 25; 86%) were observational studies [14,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]36,[39][40][41][42][43][44][45]47] (Table S3, http://links.lww.com/HJH/B268). Sample sizes varied considerably, from n ¼ 75 to n ¼ 79 958 for SPC therapy and n ¼ 73 to n ¼ 383 269 for free-dose combination therapy.…”

Section: Study Populations and Antihypertensive Therapy Prescribedmentioning

confidence: 99%

Impact of single-pill combination therapy on adherence, blood pressure control, and clinical outcomes: a rapid evidence assessment of recent literature

Tsioufis

Kreutz

Sykara

et al. 2020

Journal of Hypertension

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The 2018 European Society of Cardiology/ European Society of Hypertension Guidelines for the management of arterial hypertension raised the need for evidence to support the use of single-pill combination (SPC) therapy in preference to free-dosed therapy for hypertension. This systematic rapid evidence assessment sought to determine if initiating SPC therapy improves adherence, blood pressure (BP) control and/or cardiovascular outcomes vs. initiation of free-dose combination therapy. Methods: Rapid evidence assessment conducted in MEDLINE, EMBASE, and Cochrane Library (1 January 2013-11 January 2019) to identify studies investigating SPC therapy for adults with hypertension. Information on adherence/persistence, BP lowering/goal attainment, and cardiovascular outcomes/events were extracted via twophase screening process. Studies not focusing on adherence, persistence, or compliance with SPC therapy were excluded. Methodological quality was assessed using appropriate scales. Results: Of 863 citations, 752 failed to meet inclusion or were duplicates. Twenty-nine studies remained following full-text screening. Just four studies (14%) were randomized controlled studies; 25 (86%) were observational. A range of SPC therapies were studied, with calcium channel blocker/angiotensin receptor blocker combinations most common (11/29 studies). Adherence and persistence were generally higher with SPC vs. freedose combination therapy; 15 studies (54%) directly compared adherence and four (14%) compared persistence. Patients achieving BP targets ranged from 25 to 89%. Despite all studies investigating patients with hypertension only 16 (55%) reported change in BP. Few studies reported on cardiovascular outcomes. Methodological reporting was often suboptimal. Conclusion: Adherence and/or persistence were generally higher in patients taking antihypertensives as SPC vs. freedose combination; however, methodological reporting was suboptimal to facilitate comparison. Specifically designed, well reported studies are required to determine if the increased adherence/persistence seen in patients on SPC regimen leads to improved BP control and/or cardiovascular outcomes.

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“…Furthermore, nonadherence was also confirmed as an important contributor to the higher hospitalization rate and health care cost 20 . Currently, FDC is widely used in several chronic diseases such as hypertension, DM, and pulmonary tuberculosis to simplify treatment regimens, improving medication adherence and clinical outcomes 10,12,21‐24 . In our previous study, compared to the free combination of CCB/ARB, the FDC of amlodipine/valsartan improves MACE‐free survival, medication compliance, hospitalization rates, and also decreases total health care costs 12 .…”

Section: Discussionmentioning

confidence: 89%

“…Previously, several studies have suggested that, in hypertensive patients, fixed‐dose combination (FDC) is more effective to control blood pressure than free‐equivalent combination (FEC) or monotherapy 9‐11 . Better medication compliance with FDC regimens may significantly reduce the major adverse cardiovascular events (MACE) and health care costs, 12,13 which was also recommended by the current major guidelines 14,15 .…”

Section: Introductionmentioning

confidence: 99%

Fixed‐dose combination of amlodipine and atorvastatin improves clinical outcomes in patients with concomitant hypertension and dyslipidemia

Lin

Tung

Hsiao

et al. 2020

J of Clinical Hypertension

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Long-term persistence with single-pill, fixed-dose combination therapy versus two pills of amlodipine and perindopril for hypertension: Australian experience

Abstract: Use of a single-pill, fixed-dose combination in hypertension is associated with superior persistence and reduced mortality compared with use of two pills, suggesting a higher priority for the use of fixed-dose combinations.

Cited by 35 publications

References 10 publications

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

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

Impact of single-pill combination therapy on adherence, blood pressure control, and clinical outcomes: a rapid evidence assessment of recent literature

Fixed‐dose combination of amlodipine and atorvastatin improves clinical outcomes in patients with concomitant hypertension and dyslipidemia

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