From the Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto di Ricovero e Cura a Carattere scientifico (IRCCS), Istituto Auxologico Italiano, Milan, Italy (G.P.).
Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy (G.P.).
Hypertension. 2021 Feb;77(2):692-705. doi: 10.1161/HYPERTENSIONAHA.120.15781. Epub 2021 Jan 4.
Poor adherence to antihypertensive therapy is a major cause of poor blood pressure (BP) control in patients with hypertension. Regimen simplification may improve adherence and BP control. This systematic review assessed whether single-pill combination (SPC) therapy led to improved adherence, persistence, and better BP control compared with free-equivalent combination (FEC) therapy in patients with hypertension. PubMed, Medline, Embase, and the Cochrane Library were searched until July 2020, in addition to manual searching of relevant congress abstracts from 2014 to 2020 for studies including adults with hypertension aged ≥18 years receiving SPC or FEC antihypertensive therapy measuring any of the following: adherence, persistence, and reductions in systolic BP and/or diastolic BP. Adherence and persistence were summarized in a narrative analysis; direct pair-wise meta-analysis was conducted to compare BP reductions with SPC therapy versus FEC therapy using fixed-effect and random-effects models. Following screening, 44 studies were included. The majority (18 of 23) of studies measuring adherence showed adherence was significantly improved in patients receiving SPCs versus FECs. Overall, 16 studies measured persistence, of which 14 showed that patients receiving SPCs had significantly improved persistence or were significantly less likely to discontinue therapy than patients receiving FECs. Systolic BP (mean difference, -3.99 [95% CI, -7.92 to -0.07]; =0.05) and diastolic BP (-1.54 [95% CI, -2.67 to -0.41]; =0.0076) were both significantly reduced with SPC therapy compared with FEC therapy at week 12. SPC therapy leads to improved adherence and persistence compared with FEC therapy and may lead to better BP control in patients with hypertension.
降压治疗依从性差是高血压患者血压控制不佳的主要原因。简化治疗方案可能会提高依从性和血压控制。本系统评价评估了单药复方（SPC）治疗与自由联合复方（FEC）治疗相比，是否能提高高血压患者的依从性、持久性，并更好地控制血压。检索了 PubMed、Medline、Embase 和 Cochrane Library，检索时间截至 2020 年 7 月，并对 2014 年至 2020 年相关会议摘要进行了手工检索，以纳入包含≥18 岁接受 SPC 或 FEC 降压治疗的成年人的研究，这些研究测量了以下任何一项：依从性、持久性和收缩压和/或舒张压的降低。依从性和持久性采用叙述性分析进行总结；采用固定效应和随机效应模型，对 SPC 治疗与 FEC 治疗相比血压降低的情况进行直接成对荟萃分析。经过筛选，共纳入 44 项研究。在测量依从性的研究中，大多数（18/23）研究表明，接受 SPC 治疗的患者的依从性明显提高。总体而言，有 16 项研究测量了持久性，其中 14 项研究表明，接受 SPC 治疗的患者的持久性明显提高，或停止治疗的可能性明显低于接受 FEC 治疗的患者。与 FEC 治疗相比，SPC 治疗在第 12 周时收缩压（平均差值，-3.99 [95%CI，-7.92 至-0.07]；=0.05）和舒张压（-1.54 [95%CI，-2.67 至-0.41]；=0.0076）均显著降低。与 FEC 治疗相比，SPC 治疗可提高依从性和持久性，并可能改善高血压患者的血压控制。
