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Burnier M, Redon J, Volpe M. Single-Pill Combination with Three Antihypertensive Agents to Improve Blood Pressure Control in Hypertension: Focus on Olmesartan-Based Combinations. High Blood Press Cardiovasc Prev 2023; 30:109-121. [PMID: 36696054 PMCID: PMC10090015 DOI: 10.1007/s40292-023-00563-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
Blood pressure control remains an unmet clinical need. Only about half of patients achieve their blood pressure (BP) targets and of these, the majority require combination and double or triple therapies. International guidelines recommend the association of drugs with complementary mechanisms of action and, in particular, the combination of renin-angiotensin system (RAS) inhibitors, calcium channel blockers (CCBs), and diuretics. Among the various angiotensin receptor blockers, olmesartan (OM) is available as a monotherapy and in dual and triple single-pill combinations (SPCs) with amlodipine (AML) and/or hydrochlorothiazide (HCTZ). Several phase III and IV studies, together with real-world studies, have demonstrated the additional benefits of combining OM either with AML or with HCTZ in terms of BP control and target BP achievements both in the general population and in special subgroups of hypertensive patients, such as the elderly, diabetic, chronic kidney disease or obese patients. Ambulatory BP monitoring studies assessing 24h BP have also demonstrated that dual, as well as triple, OM-based SPCs induce a more sustained and smoother BP reduction than placebo and monotherapy. Furthermore, triple OM-based SPC has been shown to improve therapeutic adherence in hypertensive patients compared to free combinations. The availability of OM combined with HCTZ, AML or both at different dosages makes it a valuable option to customize therapy based on the levels of BP and the clinical characteristics of hypertensive patients.
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Affiliation(s)
- Michel Burnier
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
| | - Josep Redon
- Cardiovascular and Renal Research Group, INCLIVA Research Institute, University of Valencia, Valencia, Spain
- CIBERObn, ISCIII, Madrid, Spain
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, University of Rome Sapienza, Rome, Italy
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Effect of antihypertensive treatment on 24-h blood pressure variability: pooled individual data analysis of ambulatory blood pressure monitoring studies based on olmesartan mono or combination treatment. J Hypertens 2019; 36:720-733. [PMID: 29045341 PMCID: PMC5862001 DOI: 10.1097/hjh.0000000000001608] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Objective: To evaluate the impact of olmesartan alone or combined with one to three antihypertensive drugs on 24-h blood pressure variability (BPV) and on distribution of BP reduction in a pooled individual data analysis of 10 double-blind, randomized, ambulatory BP monitoring (ABPM) studies. Methods: ABPMs were performed before and after 6–12 weeks of treatment with placebo (n = 119), active control monotherapy [n = 1195, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), dihydropyridine calcium channel blockers (DCCBs)] olmesartan monotherapy (n = 1410), active control dual combination [n = 79, DCCB + thiazide diuretic (TD)], olmesartan dual combination (n = 637, DCCB or TD), and triple combination therapy (n = 102, DCCB+TD). 24-h BPV was calculated as unweighted or weighted SD of the mean BP, and average real variability. BP control was assessed by smoothness index and treatment-on-variability index. Results: The greatest effect on 24-h systolic BPV/diastolic BPV was observed under olmesartan triple [−2.6/−1.9; −1.9/−1.3; −1.4/−1.3 mmHg] and active control dual combination [−1.8/−1.4; −1.9/−1.5; −1.2/−1.1 mmHg]. Smoothness indexes and treatment-on-variability indexes were significantly (P = 0.0001) higher under olmesartan dual (1.53/1.22, 1.67/1.29, 2.05/1.59), olmesartan triple (2.47/1.85, 2.80/2.06, 3.64/2.67), or active control dual combination (1.70/1.26, 1.85/1.33, 2.29/1.65) than under monotherapies (control: 0.86/0.73, 0.80/0.65, 1.01/0.82; olmesartan: 1.02/0.86, 0.95/0.78, 1.23/1.00). They were also greater in patients receiving high-dose olmesartan monotherapy or high-dose olmesartan dual combination than in the corresponding low-dose group. Conclusion: Olmesartan plus a DCCB and/or a TD produces a larger, more sustained, and smoother BP reduction than placebo and monotherapies, a desirable feature for a more effective prevention of the cardiovascular consequences of uncontrolled hypertension.
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Presta V, Figliuzzi I, Citoni B, Miceli F, Battistoni A, Musumeci MB, Coluccia R, De Biase L, Ferrucci A, Volpe M, Tocci G. Effects of different statin types and dosages on systolic/diastolic blood pressure: Retrospective analysis of 24-hour ambulatory blood pressure database. J Clin Hypertens (Greenwich) 2018; 20:967-975. [DOI: 10.1111/jch.13283] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/23/2018] [Accepted: 03/11/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Vivianne Presta
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
| | - Ilaria Figliuzzi
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
| | - Barbara Citoni
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
| | - Francesca Miceli
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
| | - Allegra Battistoni
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
| | - Maria Beatrice Musumeci
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
| | | | - Luciano De Biase
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
| | - Andrea Ferrucci
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
| | - Massimo Volpe
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
- IRCCS Neuromed; Pozzilli Italy
| | - Giuliano Tocci
- Division of Cardiology; Department of Clinical and Molecular Medicine; Faculty of Medicine and Psychology; Sant'Andrea Hospital; University of Rome Sapienza; Rome Italy
- IRCCS Neuromed; Pozzilli Italy
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Personalised Single-Pill Combination Therapy in Hypertensive Patients: An Update of a Practical Treatment Platform. High Blood Press Cardiovasc Prev 2017; 24:463-472. [PMID: 29086364 PMCID: PMC5681620 DOI: 10.1007/s40292-017-0239-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 10/02/2017] [Indexed: 12/14/2022] Open
Abstract
Despite the improvements in the management of hypertension during the last three decades, it continues to be one of the leading causes of cardiovascular morbidity and mortality worldwide. Effective and sustained reductions in blood pressure (BP) reduce the incidence of myocardial infarction, stroke, congestive heart failure and cardiovascular death. However, the proportion of patients who achieve the recommended BP goal (< 140/90 mmHg) is persistently low, worldwide. Poor adherence to therapy, complex therapeutic regimens, clinical inertia, drug-related adverse events and multiple risk factors or comorbidities contribute to the disparity between the potential and actual BP control rate. Previously we published a practical therapeutic platform for the treatment of hypertension based on clinical evidence, guidelines, best practice and clinical experience. This platform provides a personalised treatment approach and can be used to improve BP control and simplify treatment. It uses long-acting, effective and well-tolerated angiotensin receptor blocker (ARB) olmesartan, in combination with a calcium channel blocker amlodipine, and/or a thiazide diuretic hydrochlorothiazide. These drugs were selected based on the availability in most European Countries of single-pill, fixed formulations in a wide range of doses for both dual- and triple-drug combinations. The platform approach could be applied to other ARBs or angiotensin-converting enzyme inhibitors available in single-pill, fixed-dose combinations. Here, we present an update, which takes into account the results of the recently published studies and extends the applicability of the platform to common conditions that are often neglected or poorly considered in clinical practice guidelines.
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Triple-combination therapy in the treatment of hypertension: a review of the evidence. J Hum Hypertens 2017; 31:501-510. [PMID: 28230062 DOI: 10.1038/jhh.2017.5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 09/27/2016] [Accepted: 10/20/2016] [Indexed: 12/21/2022]
Abstract
Hypertension is a serious public health concern with inadequate control of blood pressure (BP) worldwide. Contributing factors include low efficacy of drugs, underuse of combination therapies, irrational combinations, physicians' therapeutic inertia and poor adherence to treatment. Current guidelines recommend the use of initial (dual) combination therapy in high-risk patients for immediate BP response, better short- and long-term BP control, and continued/improved patient adherence. This article aims to review the existing evidence of triple-combination therapies with respect to efficacy, safety and adherence to treatment. It is estimated that three drugs are required to achieve BP control in approximately one-fourth to one-third of patients. Randomised controlled trials (RCTs) have shown that triple combinations of amlodipine/valsartan/hydrochlorothiazide, amlodipine/olmesartan/hydrochlorothiazide and amlodipine/telmisartan/hydrochlorothiazide produce greater BP reductions, with greater proportions of patients achieving BP control compared with dual therapies. Further evidence also demonstrates that triple-combination therapy is efficacious for moderate to severe hypertension, with substantial additional BP reduction over dual regimens. Both RCTs and post-marketing observational studies have shown consistent and comparable efficacy in both the general population and high-risk hypertensive subgroups. Triple therapies are generally well tolerated with adverse event profiles similar to dual regimens. In addition, fixed-dose combinations used as single pill improve patient adherence leading to better long-term BP control. Depending on regional circumstances, they may also be cost effective. Thus, single-pill triple combinations of different classes of drugs with complementary mechanisms of action help to treat patients to goal with improved efficacy and better adherence to treatment.
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Mazón P, Galve E, Gómez J, Gorostidi M, Górriz JL, Mediavilla JD. [Medical expert consensus in AH on the clinical use of triple fixed-dose antihypertensive therapy in Spain]. HIPERTENSION Y RIESGO VASCULAR 2016; 33:133-144. [PMID: 27129628 DOI: 10.1016/j.hipert.2016.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 02/29/2016] [Accepted: 03/08/2016] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The opinion of experts (different specialties) on the triple fixed-dose antihypertensive therapy in clinical practice may differ. MATERIALS AND METHODS Online questionnaire with controversial aspects of the triple therapy answered by panel of experts in hypertension (HT) using two-round modified Delphi method. RESULTS The questionnaire was completed by 158 experts: Internal Medicine (49), Nephrology (26), Cardiology (83). Consensus was reached (agreement) on 27/45 items (60%); 7 items showed differences statistically significant. Consensus was reached regarding: Predictive factors in the need for combination therapy and its efficacy vs. increasing the dose of a pretreatment, and advantage of triple therapy (prescription/adherence/cost/pressure control) vs. free combination. CONCLUSIONS This consensus provides an overview of the clinical use of triple therapy in moderate-severe and resistant/difficult to control HT.
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Affiliation(s)
- P Mazón
- Servicio de Cardiología, Hospital Clínico Universitario, Santiago de Compostela, España.
| | - E Galve
- Servicio de Cardiología, Hospital Vall d'Hebrón, Barcelona, España
| | - J Gómez
- Servicio de Medicina Interna, Hospital Infanta Sofía, Madrid, España
| | - M Gorostidi
- Servicio de Nefrología, Hospital Universitario Central de Asturias, Oviedo, España
| | - J L Górriz
- Servicio de Nefrología, Hospital Universitario Dr. Peset, Valencia, España
| | - J D Mediavilla
- Unidad de Hipertensión, Hospital Virgen de las Nieves, Granada, España
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Izzo JL, Jia Y, Zappe DH. Influence of Age and Race on 24-Hour Ambulatory Blood Pressure Responses to Valsartan, Hydrochlorothiazide, and Their Combination: Implications for Clinical Practice. J Clin Hypertens (Greenwich) 2016; 19:143-150. [DOI: 10.1111/jch.12891] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 06/30/2016] [Accepted: 07/03/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Joseph L. Izzo
- Erie County Medical Center; State University of New York at Buffalo; Buffalo NY
| | - Yan Jia
- Novartis Pharmaceuticals, Inc.; East Hanover NJ
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Olmesartan medoxomil: a guide to its use as monotherapy or in fixed-dose combinations with amlodipine and/or hydrochlorothiazide. DRUGS & THERAPY PERSPECTIVES 2016. [DOI: 10.1007/s40267-016-0335-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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9
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Kourlaba G, Gialama F, Tsioufis K, Maniadakis N. A literature review to evaluate the clinical and economic value of olmesartan for the treatment of hypertensive patients. Int J Cardiol 2016; 221:60-74. [PMID: 27404671 DOI: 10.1016/j.ijcard.2016.06.115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 05/19/2016] [Accepted: 06/21/2016] [Indexed: 12/15/2022]
Abstract
The objective of the present study was to systematically review the clinical and economic outcomes of olmesartan as monotherapy or in combination with other antihypertensive agents in the treatment of hypertension. A literature search was performed using PubMed and the Cochrane library until December 2015, with no limit on publication date. Eligible studies were selected using predetermined inclusion and exclusion criteria, limiting articles to those published in the English language. Background information of the study, participants' characteristics and study outcomes were collected. Meta-analysis of data was not performed. Fifty-five studies were included, of which fifty investigated the clinical efficacy of olmesartan and five the cost-effectiveness of olmesartan. In general results from clinical trials evaluating the efficacy of olmesartan as monotherapy and as combination therapy demonstrated that olmesartan provided better antihypertensive blood pressure-lowering efficacy and was generally well tolerated compared with other antihypertensive agents. Results from economic evaluations indicated that olmesartan may be more cost-effective than other ARBs such as losartan, valsartan, irbesartan and candesartan, having the potential of decreasing the overall medical costs of care for patients with hypertension. Evidence from the present systematic review confirms the antihypertensive efficacy and good safety profile of olmesartan both as monotherapy and as combination therapy. Olmesartan was also found to be cost-effective compared with other ARBs, though this area has yet relatively poor evidence and needs to further be explored.
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Affiliation(s)
- G Kourlaba
- EVROSTON LP, Chatzigianni Mexi 5, 115 28 Athens, Greece; Collaborative Center of Clinical Epidemiology and Outcomes Research (CLEO), Non-Profit Company, Chatzigianni Mexi 5, 115 28 Athens, Greece.
| | - F Gialama
- EVROSTON LP, Chatzigianni Mexi 5, 115 28 Athens, Greece
| | - K Tsioufis
- 1st Depertment of Cardiology, University of Athens, Hippocration Hospital, Vassilisis Sophias 114, 115 27, Greece
| | - N Maniadakis
- Department of Health Services Organization, National School of Public Health, 196 Alexandras Avenue, 115 21 Athens, Greece
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10
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de la Sierra A, Banegas JR, Vinyoles E, Gorostidi M, Segura J, de la Cruz JJ, Ruilope LM. Office and ambulatory blood pressure control in hypertensive patients treated with different two-drug and three-drug combinations. Clin Exp Hypertens 2016; 38:409-14. [PMID: 27159660 DOI: 10.3109/10641963.2016.1148160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
There is scarce information regarding ambulatory blood pressure (BP) achieved in daily practice with a wide range of antihypertensive drug combinations. We looked for differences in office and ambulatory BP among major drug combinations of two and three antihypertensive agents from a different drugs class. A total of 17187 patients treated with six types of two-drug combinations and 9724 treated with six types of three-drug combinations from the Spanish ABPM Registry were analyzed. We compared achieved office and ambulatory BP, as well as office (< 140/90 mmHg) and ambulatory (24-hour BP < 130/80; day BP < 135/85, and night BP < 120/70 mmHg) BP control among groups. The combination of renin-angiotensin system (RAS) blockers with diuretics and the triple combination of RAS blockers with diuretics and calcium channel blockers (CCB) were associated with lower values of 24-hour, daytime and nighttime BP, as well as more pronounced nocturnal BP dip. Compared with such combinations (reference), other double combinations had lower rates of ambulatory BP control. Moreover, triple combinations containing alpha blockers also had lower rates of ambulatory BP control. We conclude that even with similar office BP control, differences exist among antihypertensive two-drug and three-drug combinations with respect to ambulatory BP control achieved during treatment, with RAS blockers/diuretics and RAS blockers/CCBs/diuretics obtaining better control rates. This can help physicians choose among drug combinations in order to obtain further ambulatory BP reductions.
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Affiliation(s)
- Alejandro de la Sierra
- a Department of Internal Medicine, Hospital Mutua Terrassa , University of Barcelona , Spain
| | - José R Banegas
- b Department of Preventive Medicine and Public Health , Universidad Autónoma de Madrid, IdiPAZ/CIBERESP, Madrid , Spain
| | | | - Manuel Gorostidi
- d Department of Nephrology , Hospital Universitario Central de Asturias , Oviedo , Spain
| | - Julián Segura
- e Hypertension Unit, Hospital 12 de Octubre , Madrid , Spain
| | - Juan J de la Cruz
- d Department of Nephrology , Hospital Universitario Central de Asturias , Oviedo , Spain
| | - Luis M Ruilope
- e Hypertension Unit, Hospital 12 de Octubre , Madrid , Spain
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11
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Izzo JL. Age should not be a primary consideration in the management of hypertension. JOURNAL OF THE AMERICAN SOCIETY OF HYPERTENSION : JASH 2016; 10:12-15. [PMID: 26850523 DOI: 10.1016/j.jash.2015.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 11/11/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Joseph L Izzo
- Department of Medicine, University at Buffalo, Buffalo, NY, USA.
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12
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Rump LC, Ammentorp B, Laeis P, Scholze J. Adding Hydrochlorothiazide to Olmesartan/Amlodipine Increases Efficacy in Patients With Inadequate Blood Pressure Control on Dual-Combination Therapy. J Clin Hypertens (Greenwich) 2015; 18:60-9. [PMID: 26176708 PMCID: PMC5034748 DOI: 10.1111/jch.12621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 05/22/2015] [Accepted: 05/25/2015] [Indexed: 11/29/2022]
Abstract
This randomized, parallel‐group study in patients inadequately controlled on olmesartan medoxomil/amlodipine (OLM/AML) 40/10 mg assessed the effects of adding hydrochlorothiazide (HCTZ) 12.5 mg and 25 mg, using seated blood pressure (SeBP) measurements and ambulatory blood pressure (BP) monitoring. Enrolled patients were screened and tapered off of therapy if required. All patients received OLM/AML 40/10 mg and those with mean seated BP (SeBP) ≥140/90 mm Hg after 8 weeks (n=808) were randomized (1:1:1) to continue with OLM/AML 40/10 mg or receive OLM/AML/HCTZ 40/10/12.5 or 40/10/25 mg for a further 8 weeks. The primary endpoint was the change in seated diastolic BP (SeDBP) from the start to the end of the randomized treatment period. The addition of HCTZ 25 mg significantly reduced SeDBP (−2.8 mm Hg; P<.0001), lowered seated systolic BP (SeSBP) and ambulatory DBP and SBP, and improved BP goal rates. In patients uncontrolled on OLM/AML 40/10 mg, adding HCTZ led to further BP reductions, particularly in ambulatory BP.
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Affiliation(s)
- Lars C Rump
- Department of Nephrology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | | | | | - Jürgen Scholze
- Outpatient Clinic-Hypertension Excellence Centre ESH, Universitätsmedizin Berlin, CHARITÉ-CCM, Berlin, Germany
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13
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de la Sierra A. Supplement: Cardiology and Therapy. Cardiol Ther 2015; 4:1-3. [PMID: 26088277 PMCID: PMC4508521 DOI: 10.1007/s40119-015-0044-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Alejandro de la Sierra
- Head, Internal Medicine Department, Hospital Mútua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain,
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14
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Gorostidi M. Effect of Olmesartan-Based Therapies on Therapeutic Indicators Obtained Through Out-of-Office Blood Pressure. Cardiol Ther 2015; 4:19-30. [PMID: 26070804 PMCID: PMC4485667 DOI: 10.1007/s40119-015-0042-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Indexed: 11/03/2022] Open
Abstract
Ambulatory blood pressure (BP) correlates more significantly with hypertension-associated cardiovascular mortality and morbidity than BP obtained in the doctor's office. Assessing ambulatory BP, either through 24-h monitoring or through protocolized self-measurement at home, is essential in diagnosing and monitoring patients with hypertension. Several ambulatory BP-derived indicators are related with cardiovascular prognosis. These include 24-h, daytime and nighttime BP measurements, BP measurements obtained through home self-measurement, dipping status, morning surge, and BP variability. The objective of this article was to review the effect of olmesartan-based antihypertensive therapy on the main risk variables obtained when assessing ambulatory BP.
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Affiliation(s)
- Manuel Gorostidi
- Nephrology Department, Hospital Universitario Central de Asturias, RedinRen, Oviedo, Asturias, Spain,
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15
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Abstract
Objective The aim of the study was to measure the effects on blood pressure (BP) of the angiotensin receptor blocker azilsartan medoxomil, in 40 and 80 mg doses, combined with 5 mg of the calcium channel blocker amlodipine and to compare these effects with placebo plus amlodipine 5 mg. Methods This was a randomized, controlled, double-blind study of 6 weeks’ duration in 566 patients with stage 2 hypertension. The primary endpoint was 24-h systolic BP by ambulatory monitoring. Results The mean age of the participants was 58 years; men and women were equally represented, and baseline 24-h BP (153–154/93 mmHg) and clinic BP (165–166/94–95 mmHg) were similar across the three treatment groups. After 6 weeks, 24-h BP decreased by 25/15 mmHg in both the azilsartan medoxomil/amlodipine 40/5 and 80/5 mg groups. These reductions were each greater than the 14/8 mmHg decrease with placebo plus amlodipine 5 mg (P≤0.001 for both comparisons). All treatments were well tolerated, and adverse events did not increase with the azilsartan medoxomil doses. Edema or fluid retention was less common in both combination groups (2.6 and 2.7%) than with placebo plus amlodipine (7.6%). Conclusion Coadministration of azilsartan medoxomil with amlodipine was well tolerated and led to meaningful additional BP reductions compared with placebo plus amlodipine.
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Chrysant SG. Effectiveness of the fixed-dose combination of olmesartan/amlodipine/hydrochlorothiazide for the treatment of hypertension in patients stratified by age, race and diabetes, CKD and chronic CVD. Expert Rev Cardiovasc Ther 2014; 11:1115-24. [PMID: 24073676 DOI: 10.1586/14779072.2013.827449] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The prevalence of hypertension is high in patients with diabetes mellitus (DM), chronic kidney disease (CKD) and chronic cardiovascular disease (CVD), as well as in black and elderly subjects. In addition, these subjects have the lowest control of blood pressure (BP) among the hypertensive population, and also the risk of having a morbid or fatal cardiovascular event >20% in 10 years. For these reasons, aggressive control of BP to <130/80 mm Hg for these subjects is strongly recommended by National and International guidelines. To accomplish this goal, combination therapy with two or more antihypertensive drugs with a complementary mechanism of action is necessary. Drugs that block the renin-angiotensin system (RAS) in combination with a calcium channel blocker (CCB) and a diuretic have been shown to be the most effective combinations to accomplish this goal. However, this will require the administration of multiple drugs given separately, which will decrease the patient compliance and adherence to treatment. Poor patient compliance and adherence to treatment is a major factor for poor BP control. Several studies have shown that patient compliance is inversely related to the number of drugs being administered. To overcome this problem, several dual and triple-drug, fixed-dose combinations with a RAS blocker, a CCB and a diuretic have been developed and marketed, which are easier to administer, and have been shown to increase patient compliance and adherence to treatment. In this concise review, the effectiveness and safety of the fixed-dose, triple-combination of the RAS blocker olmesartan medoxomil, the CCB amlodipine besylate and the diuretic hydrochlorothiazide, as well as other similar combinations for the treatment of hypertension, will be discussed. These drug combinations have been shown to be effective, safe and well tolerated by most patients.
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Affiliation(s)
- Steven G Chrysant
- Department of Cardiology, University of Oklahoma College of Medicine, 5700 Mistletoe Court, Oklahoma City, OK 73142, USA +1 405 721 6662 +1 405 721 8417
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Clinical Impact of Patient Adherence to a Fixed-Dose Combination of Olmesartan, Amlodipine and Hydrochlorothiazide. Clin Drug Investig 2014; 34:403-11. [DOI: 10.1007/s40261-014-0188-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Omboni S, Malacco E, Mallion JM, Fabrizzi P, Volpe M. Olmesartan vs. ramipril in elderly hypertensive patients: review of data from two published randomized, double-blind studies. High Blood Press Cardiovasc Prev 2014; 21:1-19. [PMID: 24435506 DOI: 10.1007/s40292-013-0037-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 12/30/2013] [Indexed: 12/22/2022] Open
Abstract
Hypertension is a frequent condition among individuals over 65 years of age worldwide and is one of the most important risk factors for cardiovascular (CV) disease. Effective drug treatment of elderly hypertensives is usually associated with a marked reduction in CV morbidity and mortality. Among the different classes of antihypertensive agents, angiotensin receptor blockers (ARBs) and ACE-inhibitors are supposed to provide the best efficacy in lowering blood pressure (BP) and protecting target organ damage while featuring a good tolerability profile. However, up to date, few randomized clinical studies have directly compared the activity and safety of ARBs and ACE-inhibitors in elderly hypertensive patients. Aim of this review of published and unpublished pooled data from two recent randomized, double-blind, controlled trials, is to offer a comprehensive head-to-head comparison of the antihypertensive efficacy of the ARB olmesartan medoxomil vs. the ACE-inhibitor ramipril in a large study population including more than 1,400 hypertensive subjects aged 65-89 years with mild-to-moderate essential hypertension. The efficacy of the two drugs was separately evaluated in subgroups of patients classified according to the presence of metabolic syndrome, reduced renal function, CV risk level, gender, class of age, type of arterial hypertension and previous antihypertensive treatments. Olmesartan showed a greater efficacy than ramipril both in terms of clinic BP reduction and rate normalization. Olmesartan appeared significantly superior to ramipril in providing a more homogeneous and long-lasting 24-h BP control and maintaining an effective antihypertensive action in the last 6-h period from drug intake. In subgroups of patients with additional clinical conditions, olmesartan gave comparable, and in some cases greater, BP responses than those achieved with the ACE-inhibitor. The incidence of adverse events was similar for both drugs. Olmesartan may thus represent an effective alternative to ACE-inhibitors among first-line drug treatments for hypertension in older people.
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Affiliation(s)
- Stefano Omboni
- Italian Institute of Telemedicine, Via Colombera 29, 21048, Solbiate Arno (Varese), Italy,
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Weber MA. Exploring Issues in Difficult-to-Treat Hypertension. J Clin Hypertens (Greenwich) 2013; 15:859-64. [DOI: 10.1111/jch.12219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Michael A. Weber
- Division of Cardiovascular Medicine; Downstate College of Medicine; State University of New York; Brooklyn NY
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Combination therapy for hypertension 2013: An update. ACTA ACUST UNITED AC 2013; 7:401-7. [DOI: 10.1016/j.jash.2013.04.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 04/30/2013] [Accepted: 04/30/2013] [Indexed: 11/19/2022]
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Epstein BJ, Shah NK, Borja-Hart NL. Management of hypertension with fixed-dose triple-combination treatments. Ther Adv Cardiovasc Dis 2013; 7:246-59. [DOI: 10.1177/1753944713498638] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The objective of this review is to evaluate the role of fixed-dose triple-combination therapy for the management of hypertension. An assessment of clinical trials showed that half the patients with hypertension have uncontrolled blood pressure (BP), with underlying factors including therapeutic inertia and poor patient adherence. Many patients will require three antihypertensive agents to achieve BP goals, and current guidelines recommend combining drugs with complementary mechanisms of action. Three single-pill triple-combination treatments are available and each includes an agent affecting the renin-angiotensin-aldosterone pathway (either a direct renin inhibitor or an angiotensin II receptor blocker) in combination with a calcium channel blocker and diuretic. These triple-combination therapies consistently demonstrated significantly greater BP reduction relative to the component dual combinations, with BP reductions documented across a range of patient populations. Triple-combination treatments were well tolerated in all clinical trials reviewed. The use of single-pill, triple-combination antihypertensive therapy has been shown to be an effective, well-tolerated, and convenient treatment strategy that can help patients achieve BP control.
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Affiliation(s)
- Benjamin J. Epstein
- University of Florida College of Pharmacy, Department of Pharmacotherapy and Translational Research, PO Box 100486, 1600 SW Archer Road, Gainesville, FL 32610, USA
| | - Niren K. Shah
- East Coast Institute for Research, Jacksonville, FL, USA
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Song S, Carrothers TJ, Moore H, Green M, Miller R, Rohatagi S, Lee J, Wang A, Melino M, Patel M, Heyrman R, Salazar DE. Model-Supported Development of CS-8635: A Fixed-Dose Combination of Olmesartan, Amlodipine, and Hydrochlorothiazide. Clin Pharmacol Drug Dev 2013; 2:103-12. [DOI: 10.1002/cpdd.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 11/12/2012] [Indexed: 11/08/2022]
Affiliation(s)
- SaeHeum Song
- Daiichi Sankyo Pharma Development; Edison, NJ; USA
| | | | - Helen Moore
- Pharsight, a Certara Company; Sunnyvale, CA; USA
| | | | | | | | - James Lee
- Daiichi Sankyo Pharma Development; Edison, NJ; USA
| | - Antonia Wang
- Daiichi Sankyo Pharma Development; Edison, NJ; USA
| | | | - Manini Patel
- Daiichi Sankyo Pharma Development; Edison, NJ; USA
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Paz Bermejo MA. Selección de olmesartán en monoterapia, combinación o triple terapia en función del descenso necesario de la presión arterial. HIPERTENSION Y RIESGO VASCULAR 2013. [DOI: 10.1016/s1889-1837(13)70017-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Aspectos prácticos de la combinación de 3 fármacos antihipertensivos a dosis fijas. HIPERTENSION Y RIESGO VASCULAR 2013. [DOI: 10.1016/s1889-1837(13)70016-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Kizilirmak P, Berktas M, Uresin Y, Yildiz OB. The efficacy and safety of triple vs dual combination of angiotensin II receptor blocker and calcium channel blocker and diuretic: a systematic review and meta-analysis. J Clin Hypertens (Greenwich) 2012; 15:193-200. [PMID: 23458592 DOI: 10.1111/jch.12040] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Many hypertensive patients require ≥2 drugs to achieve blood pressure targets. This study aims to review and analyze the clinical studies conducted with dual or triple combination of angiotensin II receptor blockers (ARBs), calcium channel blockers (CCBs), and diuretics. Medical literature between January 1990 and April 2012 was reviewed systematically and data from eligible studies were abstracted. Data were analyzed using random-effects models. Of the 224 studies screened, 7563 eligible patients from 11 studies were included. Triple combinations of ARBs (olmesartan or valsartan), CCBs (amlodipine), and diuretics (hydrochlorothiazide) at any dose provided more blood pressure reduction in office and 24-hour ambulatory measurements than any dual combination of these molecules (P<.0001 for both). Significantly more patients achieved blood pressure targets with triple combinations (odds ratio, 2.16; P<.0001). Triple combinations did not increase adverse event risk (odds ratio, 0.96; P=.426). Triple combinations at any dose seem to decrease blood pressure more effectively than dual combination of the same molecules without any remarkable risk elevation for adverse events. Further prospective studies evaluating the efficacy and safety of triple combinations, especially in the form of single pills, are required.
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Affiliation(s)
- Pinar Kizilirmak
- Department of Pharmacology, Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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Abstract
Uncontrolled hypertension imposes a substantial global health burden, and poor patient compliance with prescribed antihypertensive medication makes a major contribution to the development of suboptimal blood pressure (BP) control. The asymptomatic nature of hypertension, side effects of medication, treatment complexity, and high pill burdens all have a negative impact on patient compliance. It is important to address the issue of poor patient compliance as studies have shown that good compliance is associated with improvement of BP control and positive health outcomes. As the majority of hypertensive patients require treatment with two or more agents to achieve goal BP, treatment guidelines have acknowledged the value of simplifying treatment through the use of fixed-dose combination (FDC) therapy. Triple FDC therapy comprising an angiotensin II type 1 receptor antagonist (angiotensin receptor blocker), calcium channel blocker, and thiazide diuretic is a novel treatment strategy for the improvement of BP control in hard-to-treat patients.
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Affiliation(s)
- Serap Erdine
- Department of Cardiology, Cerrahpaşa School of Medicine, Istanbul University, Istanbul, Turkey.
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Erdine S. How do Compliance, Convenience, and Tolerability Affect Blood Pressure Goal Rates? Am J Cardiovasc Drugs 2012. [DOI: 10.2165/11635450-000000000-00000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Volpe M, Tocci G. Rationale for triple fixed-dose combination therapy with an angiotensin II receptor blocker, a calcium channel blocker, and a thiazide diuretic. Vasc Health Risk Manag 2012; 8:371-80. [PMID: 22745561 PMCID: PMC3383291 DOI: 10.2147/vhrm.s28359] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Hypertension is a growing global health problem, and is predicted to affect 1.56 billion people by 2025. Treatment remains suboptimal, with control of blood pressure achieved in only 20%-35% of patients, and the majority requiring two or more antihypertensive drugs to achieve recommended blood pressure goals. To improve blood pressure control, the European hypertension guidelines recommend that angiotensin II receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors (ACEIs) are combined with calcium channel blockers (CCBs) and/or thiazide diuretics. The rationale for this strategy is based, in part, on their different effects on the renin-angiotensin system, which improves antihypertensive efficacy. Data from a large number of trials support the efficacy of ACEIs or ARBs in combination with CCBs and/or hydrochlorothiazide (HCTZ). Combining two different classes of antihypertensive drugs has an additive effect on lowering of blood pressure, and does not increase adverse events, with the ARBs showing a tolerability advantage over the ACEIs. Among the different ARBs, olmesartan medoxomil is available as a dual fixed-dose combination with either amlodipine or HCTZ, and the increased blood pressure-lowering efficacy of these two combinations is proven. Triple therapy is required in 15%-20% of treated uncontrolled hypertensive patients, with a renin-angiotensin system blocker, CCB, and thiazide diuretic considered to be a rational combination according to the European guidelines. Olmesartan, amlodipine, and HCTZ are available as a triple fixed-dose combination, and significant blood pressure reductions have been observed with this regimen compared with the possible dual combinations. The availability of these fixed-dose combinations should lead to improvement in blood pressure control and aid compliance with long-term therapy, optimizing the management of this chronic condition.
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Affiliation(s)
- Massimo Volpe
- Division of Cardiology, Department of Clinical and Molecular Medicine, University of Rome, Sapienza, Sant'Andrea Hospital, Rome, Italy.
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de la Sierra A, Barrios V. Blood pressure control with angiotensin receptor blocker-based three-drug combinations: key trials. Adv Ther 2012; 29:401-15. [PMID: 22610686 DOI: 10.1007/s12325-012-0019-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Most hypertensive patients only achieve blood pressure (BP) control with a combination of antihypertensive drugs from different classes and many require three or more drugs. Two three-drug, fixed-dose combinations are available: (1) the angiotensin receptor blocker (ARB), valsartan (VAL), the calcium channel blocker, amlodipine (AML), and the diuretic, hydrochlorothiazide (HCTZ); (2) the ARB, olmesartan medoxomil (OLM), AML, and HCTZ. METHODS This article reviews two clinical studies in patients with moderate-to-severe hypertension, which compared the efficacy and safety of VAL/AML/HCTZ and OLM/AML/HCTZ with the component two-drug combinations. RESULTS Each triple combination produced significantly greater reductions in seated systolic/diastolic BP and higher BP control rates than the two-drug combinations. Subgroup analyses showed that BP reductions and control rates with the three-drug combinations were unaffected by age, gender, race, and hypertension severity (VAL/AML/HCTZ and OLM/AML/HCTZ), and that efficacy was maintained for up to 52 weeks (OLM/AML/HCTZ). OLM/AML/HCTZ and VAL/AML/HCTZ also produced significantly larger reductions in ambulatory systolic and diastolic BP over 24 hours, the daytime, and nighttime compared with two-drug combinations. Adverse events were mainly of mild or moderate intensity and each threedrug combination was well tolerated. CONCLUSION ARB/AML/HCTZ combinations produce BP reductions and control rates superior to two-drug combinations and may help difficult-to-treat patients to achieve BP control.
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Affiliation(s)
- Alejandro de la Sierra
- Department of Internal Medicine, Hospital Mutua Terrassa, University of Barcelona, Plaza Dr. Robert, 5, 08221, Terrassa, Spain.
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Taylor AA, Ragbir S. Three in one: safety, efficacy, and patient acceptability of triple fixed-dose combination medicine in the management of hypertension. Patient Prefer Adherence 2012; 6:555-63. [PMID: 22927748 PMCID: PMC3422120 DOI: 10.2147/ppa.s14764] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Hypertensive patients whose blood pressures are more than 20 mmHg above their goal will often require three or more medications. Careful selection of medications whose actions are complementary or have an improved adverse effect profile when combined can affect not only the blood pressure but also patient acceptance, thus improving persistence in taking the medications as prescribed. This review will highlight the three single-pill three-drug combinations currently available in the US and will address their efficacy, safety, and tolerability. All three include the dihydropyridine calcium-channel blocker, amlodipine, and the thiazide diuretic, hydrochlorothiazide. They each contain a different renin-angiotensin system blocker. One includes the angiotensin-receptor blocker, olmesartan, while another contains valsartan. The third combination includes the direct renin inhibitor, aliskiren. All three fixed-dose combinations (FDC) at maximum doses of each component lowers the blood pressure of patients with stage II hypertension by 37 to 40 mmHg systolic and 21 to 25 mmHg diastolic, which is superior to any two of the components that comprise the three-drug FDC. These drugs are effective in males and females, the elderly, diabetics, minority populations, and patients with metabolic syndrome. Triple-drug FDCs are well tolerated with a low incidence of adverse effects, the most common being peripheral edema related to amlodipine. Extrapolation of data from two-drug FDC suggests that medication compliance (adherence and persistence) should be better with these FDCs than with the individual components taken as separate medications, although additional studies are necessary to confirm this.
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Affiliation(s)
- Addison A Taylor
- Correspondence: Addison A Taylor, Department of Medicine, Baylor College of Medicine, 1709 Dryden Road, Suite 600, MS620, Houston, TX 77030, USA, Email
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