Title:Optimizing the Management of Uncontrolled Hypertension: What do Triple Fixed-Dose Drug Combinations Add?
Volume: 16
Issue: 1
Author(s): Costas Thomopoulos*, Georgios Katsimagklis, Stefanos Archontakis, Georgios Skalis and Thomas Makris
Affiliation:
- Department of Cardiology, Helena Venizelou Hospital, Athens,Greece
Keywords:
Fixed-drug combination, hypertension, uncontrolled hypertension, resistant hypertension, blood pressure, blood
pressure lowering.
Abstract: Fixed-dose triple drug combinations represent one of the latest innovations of pharmacotherapy
for hypertension (HT). They combine a traditional renin-angiotensin system blocker, a diuretic and
a calcium channel blocker. The main benefit is the simplification of treatment regimen because 3 different
agents are combined at different doses in a single pill. Improving adherence to treatment partly explains
why this kind of combination may effectively reduce blood pressure (BP). BP lowering by a single-
pill triple-drug combination can be approximately predicted, by using appropriate formulas described
in previous meta-analysis of randomized trials. Thus, clinicians may select the appropriate dose
for each of the combined drugs. Selection of different types of fixed-dose triple-drug combinations relies
upon clinical experience, commercial availability and evidence from clinical trials and metaanalyses
for each agent alone. However, triple fixed-dose drug combinations should be reserved only for
patients with uncontrolled BP with 2 agents, poor adherence in complex therapeutic regimens or on
inappropriate free-drug combinations. Also, triple therapy may help overcome clinical inertia by prescribing
more potent antihypertensive formulations in one pill.
In contrast, this type of multiple-drug fixed-dose combination might be less safe in very old and frail
patients, as well as in those with chronic kidney disease. Although new combinations may help overcome
the clinical inertia of achieving individualized BP targets, doctors should also pay attention reinforcement
of lifestyle changes.