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Review
. 2020 Oct;22(10):1769-1779.
doi: 10.1111/jch.14009. Epub 2020 Aug 20.

Two-drug fixed-dose combinations of blood pressure-lowering drugs as WHO essential medicines: An overview of efficacy, safety, and cost

Abdul Salam  1 , Mark D Huffman  2   3 , Raju Kanukula  1 , Esam Hari Prasad  1 , Abhishek Sharma  4   5 , David J Heller  6 , Rajesh Vedanthan  7 , Anubha Agarwal  8 , Anthony Rodgers  3 , Marc G Jaffe  9 , Thomas R Frieden  10 , Sandeep P Kishore  6   10   11
Affiliations
Review

Two-drug fixed-dose combinations of blood pressure-lowering drugs as WHO essential medicines: An overview of efficacy, safety, and cost

Abdul Salam et al. J Clin Hypertens (Greenwich). 2020 Oct.

Abstract

Cardiovascular diseases (CVD) are the world's leading cause of death. High blood pressure (BP) is the leading global risk factor for all-cause preventable morbidity and mortality. Globally, only about 14% of patients achieve BP control to systolic BP <140 mm Hg and diastolic BP <90 mm Hg. Most patients (>60%) require two or more drugs to achieve BP control, yet poor adherence to therapy is a major barrier to achieving this control. Fixed-dose combinations (FDCs) of BP-lowering drugs are one means to improve BP control through greater adherence and efficacy, with favorable safety and cost profiles. The authors present a review of the supporting data from a successful application to the World Health Organization (WHO) for the inclusion of FDCs of two BP-lowering drugs on the 21st WHO Essential Medicines List. The authors discuss the efficacy and safety of FDCs of two BP-lowering drugs for the management of hypertension in adults, relevant hypertension guideline recommendations, and the estimated cost of such therapies.

Keywords: antihypertensive therapy; combination therapy; hypertension-general.

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Conflict of interest statement

The George Institute for Global Health has a patent and license and has received investment funding with intent to commercialize fixed‐dose combination therapy through its social enterprise business, George Medicines. Dr Sandeep P. Kishore serves as a consultant for Resolve to Save Lives for hypertension control, a clinical fellow at Harvard Medical School/Brigham & Women's Hospital and has led a partnership on multiple chronic conditions supported by the Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai and Teva Pharmaceuticals. Dr Mark D. Huffman(MDH) has received support from the American Heart Association, Verily, and AstraZeneca for work unrelated to this research. MDH has received salary support from the American Medical Association for his role as an associate editor for JAMA Cardiology. MDH has a secondary appointment at The George Institute for Global Health, which has a patent, license, and intent to commercialize fixed‐dose combination therapy through its social enterprise business, George Medicines, for which the organization has received investments. Mr Abhishek Sharma is an employee of the PRECISIONheor (a Precision Value & Health | Precision Medicine Group team) that provides health economics and policy research consulting services to, and has received payments from, biopharmaceutical companies for work unrelated to this research. Dr David J. Heller reports support from Teva Pharmaceuticals. However, Teva Pharmaceuticals was not involved in any aspect of the design, conduct, or analysis of this study; the content of this manuscript; nor the decision to publish.

Figures

Figure 1
Figure 1
Effects of combination therapy vs placebo on coronary heart disease, stroke, and death in different patient groups. C, control; CHD, coronary heart disease; CV, cardiovascular; DBP, diastolic blood pressure; I, intervention; SBP, systolic blood pressure; TIA, transient ischemic attack
See this image and copyright information in PMC

References

    1. Roth GA, Johnson C, Abajobir A, et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol. 2017;70(1):1‐25. - PMC - PubMed
    1. Mills KT, Bundy JD, Kelly TN, et al. Global disparities of hypertension prevalence and control: a systematic analysis of population‐based studies from 90 countries. Circulation. 2016;134(6):441‐450. - PMC - PubMed
    1. Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42(6):1206‐1252. - PubMed
    1. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31(7):1281‐1357. - PubMed
    1. Chow CK, Teo KK, Rangarajan S, et al. Prevalence, awareness, treatment, and control of hypertension in rural and urban communities in high‐, middle‐, and low‐income countries. JAMA. 2013;310(9):959‐968. - PubMed

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