Division of Nephrology and Hypertension Consultation, CHUV, Lausanne, Switzerland.
Int J Clin Pract. 2009 May;63(5):790-8. doi: 10.1111/j.1742-1241.2009.01999.x. Epub 2009 Feb 11.
Hypertension (HTN) is a major risk factor for cardiovascular mortality, yet only a small proportion of hypertensive individuals receive appropriate therapy and achieve target blood pressure (BP) values. Factors influencing the success of antihypertensive therapy include physicians' acceptance of guideline BP targets, the efficacy and tolerability of the drug regimen, and patient compliance and persistence with therapy. It is now well recognised that most hypertensive patients require at least two antihypertensive agents to achieve their target BP. However, complicated treatment regimens are a major contributory factor to poor patient compliance. The use of combination therapy for HTN offers a number of advantages over the use of monotherapy, including improved efficacy, as drug combinations with a synergistic mechanism of action can be used. This additive effect means that lower doses of the individual components can be used, which may translate into a decreased likelihood of adverse events. The use of single-pill combination therapy, in which two or more agents are combined in a single dosage form, offers all the benefits of free combination therapy (improved efficacy and tolerability over monotherapy) together with the added benefit of improved patient compliance because of the simplified treatment regimen. The use of single-pill combination therapy may also be associated with cost savings compared with the use of free combinations for reasons of cheaper drug costs, fewer physician visits and fewer hospitalisations for uncontrolled HTN and cardiovascular events. Thus, the use of single-pill combination therapy for HTN should help improve BP goal attainment through improved patient compliance, leading to reduced costs for cardiovascular-related care.
高血压（HTN）是心血管死亡率的主要危险因素，但只有一小部分高血压患者接受了适当的治疗并达到了目标血压（BP）值。影响降压治疗成功的因素包括医生对指南 BP 目标的接受程度、药物治疗方案的疗效和耐受性，以及患者对治疗的依从性和持久性。现在人们已经认识到，大多数高血压患者需要至少两种降压药物才能达到目标血压。然而，复杂的治疗方案是导致患者依从性差的一个主要因素。联合治疗高血压有许多优于单药治疗的优点，包括提高疗效，因为具有协同作用机制的药物联合使用可以增效。这种附加效应意味着可以使用较低剂量的单个成分，这可能降低不良反应的发生几率。使用单片复方制剂，即将两种或更多种药物组合在一个单一剂量形式中，结合了自由联合治疗的所有优点（与单药治疗相比，疗效和耐受性更好），同时由于简化了治疗方案，还提高了患者的依从性。与使用自由组合相比，单片复方制剂的使用可能还与成本节约有关，原因是药物成本更低、医生就诊次数更少、因高血压和心血管事件失控而住院的次数更少。因此，高血压的单片复方制剂治疗应该有助于通过提高患者的依从性来提高血压达标率，从而降低与心血管相关的治疗费用。
