Unit of Hypertension, Hospital Español de Mendoza. School of Medicine. National University of Cuyo. IMBECU-CONICET, Mendoza, Argentina.
Sanatorio Británico Cardiology Institute, Rosario, Argentina.
J Hum Hypertens. 2023 Jun;37(6):438-448. doi: 10.1038/s41371-021-00557-w. Epub 2021 Jun 4.
The present document provides scientific evidence reviewed and analysed by a group of specialist clinicians in hypertension that aims to give an insight into a pharmacological strategy to improve blood pressure control. Evidence shows that most hypertensive patients will need at least two drugs to achieve blood pressure goals. There is ample evidence showing that treatment adherence is inversely related to the number of drugs taken. Observational studies show that use of drug combinations to initiate treatment reduces the time to reach the treatment goal and reduces CVD, especially with single pill combinations (SPCs). This work, based on recommendations of the Argentine Federation of Cardiology and Argentine Society of Hypertension as a reference, aims to review the more recent evidence on SPC, and to serve as guidelines for health professionals in their clinical practice and to the wider use of SPCs for the treatment of hypertension. Evidence from clinical trials on the effectiveness and adverse effects of using SPCs are provided. An analysis is also made of the main contributions of SPCs in special populations, e.g., elderly and diabetic patients, and its use in high risk and resistant hypertension. The effects of SPCs on hypertensive-mediated organ damage is also examined. Finally, we provide some aspects to consider when choosing treatments in the economic context of Latin-America for promoting the most efficient use of resources in a scarce environment and to provide quality information to decision makers to formulate safe, cost-effective, and patient-centered health policies. Finally, future perspectives and limitations in clinical practice are also discussed.
本文件提供了一组高血压专科临床医生审查和分析的科学证据,旨在深入了解改善血压控制的药理学策略。证据表明,大多数高血压患者至少需要两种药物才能达到血压目标。有大量证据表明,治疗依从性与服用药物的数量呈反比。观察性研究表明,使用药物联合治疗来启动治疗可以缩短达到治疗目标的时间,并降低心血管疾病(CVD)的风险,尤其是使用单片复方制剂(SPC)。这项工作以阿根廷心脏病学联合会和阿根廷高血压学会的建议为参考,旨在回顾 SPC 的最新证据,并为卫生专业人员的临床实践以及更广泛地使用 SPC 治疗高血压提供指导。提供了关于使用 SPC 的有效性和不良反应的临床试验证据。还分析了 SPC 在特殊人群(如老年和糖尿病患者)中的主要贡献,以及在高危和难治性高血压中的应用。还研究了 SPC 对高血压介导的器官损伤的影响。最后,我们提供了在拉丁美洲的经济背景下选择治疗方法时需要考虑的一些方面,以促进在资源稀缺的环境中最有效地利用资源,并为决策者提供安全、具有成本效益和以患者为中心的卫生政策制定提供优质信息。最后,还讨论了临床实践中的未来展望和局限性。