high blood pressure

A group of researchers in Canada evaluated whether single-pill fixed-dose combination therapy provided better treatments for high blood pressure compared to traditional multiple pills medications.

High blood pressure is the number one risk factor for stroke and many heart diseases. Systolic blood pressure at or above 140 mmHg or a diastolic blood pressure at or above 90 mmHg can be considered as high blood pressure. An individual can have high blood pressure for years with no signs or symptoms. According to Statistics Canada, more than 7.5 million Canadians have high blood pressure, causing the nation over 14 billion dollars each year in medications and healthcare services.

High blood pressure increases an individual’s risk of heart attack, stroke, chronic heart failure, vision loss, and even kidney disease. Signs and symptoms include dizziness, headaches, vision problems, and shortness of breath. The causes of high blood pressure have long been linked to aging, smoking, obesity, and nutrition.

Many people with high blood pressure take multiple pills at once

The majority of people with high blood pressure take multiple pills at once to achieve blood pressure control. In high-income countries around the world, up to 40% of patients with high blood pressure are on multiple-pill regimens. Often people find it difficult to remember to take all medications at the right time. This results in patients not sticking to their medications and increases their risks for harmful outcomes.

In a recent study published in PLOS Medicine, a group of researchers in Canada evaluated the efficacy and safety of applying single-pill fixed-dose combination therapy in treating high blood pressure. A fixed-dose combination therapy includes two or more active medications in a single pill. The researchers followed 13,350 Ontario residents aged 66 years and older who were newly received multiple pills for the treatment and prevention of heart attacks. The data was collected by Cancer Care Ontario and the Canadian Institute for Health Information between 2004 and 2014.

Single-pill combination treatment resulted in better outcomes

After five years of follow up, the researchers found that the primary outcomes of death or hospitalisation after a heart attack, heart failure, or stroke occurred at a much lower rate in the single-pill fixed-dose combination treatment group than the multiple pills group.

Despite the strengths of this study, there are certain limitations which need to be addressed, most importantly the sample size and age groups. There was also a lack of data regarding cause of death and blood pressure measurements.

This exciting study supports the benefit of applying single-pill fixed-dose combination therapy in treating high blood pressure with lower risk of composite clinical outcomes and better medication adherence. While many societies around the world do not recommend fixed-dose combination therapies for high blood pressure, the results of this study show that a simpler and low-cost solution to reduce the burden of high blood pressure around the world.

Written by Man-tik Choy, Ph.D

Reference: Verma AA, Khuu W, Tadrous M, Gomes T, Mamdani MM (2018). Fixed-dose combination antihypertensive medications, adherence, and clinical outcomes: A population-based retrospective cohort study. PLoS Med 15(6): e1002584. https://doi.org/10.1371/journal.pmed.1002584.

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