Antihypertensive 'polypill' reduces blood pressure more than standard doses of commonly used medications

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Treament of hypertension with a polypill is more effacious than single-drug treatment, according to a randomized, controlled, open-label trial.

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The authors stated that pill or tablet burden is a strong predictor of poor patient adherence to antihypertensive therapy, but acknowledged that many recent studies in hypertension and current treatment guidelines emphasize the importance of adequate blood pressure control, which typically requires >1, and often ≥3, agents. They stated that a polypill offers efficacy, cost, and adherence benefits and a reduction in the possibility of drug toxicity.

This study included 108 patients with uncontrolled and treatment-näive hypertension. Mean age was 50+/-1 years; 55% of patients were male; mean systolic blood pressure (SBP) was 160+/-1 mmHg and mean diastolic blood pressure (DBP) was 96+/-1 mmHg. The patients were randomly assigned to receive 1 of 5 once-daily therapies: amlodipine 5 mg (n=22), atenolol 50 mg (n=20), bendroflumethiazide 2.5 mg (n=22), captopril 100 mg (n=22), or a capsule containing one-quarter dose of each of the aforementioned drugs (n=22).

In a related editorial, John L. Reid, DM (doctor of medicine), stated: "This is a relatively short-term study lasting a few weeks but otherwise provides intriguing prospects for enhanced efficacy of multiple-drug combinations in low doses compared with standard therapy."

Approximately 53 million Americans (1 in 3) have been diagnosed with hypertension. Approximately 69% of people who have a first myocardial infarction, 77% who have a first stroke, and 74% who have heart failure also have blood pressures >140/90 mmHg.

SOURCES

Mahmud A, Feely J. Low-dose quadruple antihypertensive combination: More efficacious than individual agents-a preliminary report. Hypertension. 2007;49:272–275.

Reid JL. Fall and rise of polypharmacy? [editorial] Hypertension. 2007;49:266–267.

Thom T, Haase N, Rosamond W, et al. Heart disease and stroke statistics-2006 Update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee [errata in: Circulation. 2006;113:e696; and Circulation. 2006;114:e630.]Circulation. 2006;113:e85–151.

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