Single-pill combination for hypertension linked with improved clinical outcomes and adherence, study finds

Doctor measuring a patient's blood pressure

Single-pill fixed-dose combination (FDC) treatment for hypertension improves medication adherence and is linked with a significantly lower risk of heart attack, heart failure or stroke, a study has found.

The population-based retrospective cohort study, published in PLoS Medicine
[1]
, compared clinical outcomes and medication adherence with single-pill FDC treatment therapy versus multi-pill combination therapy.

Researchers followed 13,350 individuals aged 66 years and over who were newly initiated on one angiotensin-converting enzyme inhibitor (ACEI), or angiotensin II-receptor blocked (ARB) plus one thiazide diuretic, either as an FDC or a multi-pill combination.

After five years follow up, the researchers found that the median time to the first case of medication discontinuation, defined as any break in therapy of greater than 150% of the previous days’ supply, was 191 days in the FDC group and 150 days in the multi-pill group.

Discontinuation occurred in 88.7% of individuals receiving multi-pill treatment and 83.1% in the FDC group.

When examining use of the index antihypertensives over the entire study period, the proportion of days covered was 70% in the FDC group, which was significantly greater than the 42% seen in the multi-pill group.

In addition, the primary outcomes of death or hospitalisation after heart attack, heart failure or stroke occurred at a significantly lower rate in the FDC group compared with the multi-pill group (3.4 versus 3.9 events per 100 person-years, respectively).

“Using single-pill combinations rather than multiple pills may represent a simple and potentially low-cost intervention that could substantially reduce the global burden of death and disability related to hypertension,” the authors wrote.

References

[1] Verma A, Khuu W, Tadrous M et al. Fixed-dose combination antihypertensive medications, adherence, and clinical outcomes: a population-based retrospective cohort study. PLoS Med 2018;15(6):e1002584. doi: 10.1371/journal.pmed.1002584

Last updated
Citation
The Pharmaceutical Journal, June 2018;Online:DOI:10.1211/PJ.2018.20204999