Fixed-dose triple-combination treatments in the management of hypertension

Abstract

Hypertension remains uncontrolled in approximately 50% of patients with hypertension, which increases the risk of cardiovascular morbidity and mortality in these individuals. A key factor contributing to poor blood pressure (BP) control is nonadherence to prescribed antihypertensive medications. Improving patient adherence to antihypertensive therapy is the key to improving BP goal attainment. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommend a stepwise treatment algorithm for patients with stage 1 hypertension, with initial treatment consisting of a single antihypertensive drug. For most patients, however, combinations of 2 or more antihypertensive agents are necessary for adequate BP control. Antihypertensive regimens that combine agents from different antihypertensive drug classes can facilitate attainment of BP goals and improve cardiovascular outcomes at lower drug doses compared with monotherapy. Patient adherence to antihypertensive therapy decreases with increasing number of pills in multiple pill regimens, but fixed-dose triple-combination treatments for hypertension provide a tool for addressing patient nonadherence associated with pill burden. For patients whose antihypertensive therapy includes multiple medications, the use of a single-pill, fixed-dose combination therapy can significantly improve compliance and thereby help patients achieve BP goals. In addition, single-pill combinations may reduce health care utilization and medical costs compared with multiple single-pill therapies. The purpose of this article is to review the role of novel single-pill, fixed-dose, triple-combination treatments for modern hypertension management.