Triple-combination therapy in the treatment of hypertension: a review of the evidence.

Détails

ID Serval
serval:BIB_D16FD421330A
Type
Article: article d'un périodique ou d'un magazine.
Sous-type
Synthèse (review): revue aussi complète que possible des connaissances sur un sujet, rédigée à partir de l'analyse exhaustive des travaux publiés.
Collection
Publications
Titre
Triple-combination therapy in the treatment of hypertension: a review of the evidence.
Périodique
Journal of human hypertension
Auteur(s)
Düsing R., Waeber B., Destro M., Santos Maia C., Brunel P.
ISSN
1476-5527 (Electronic)
ISSN-L
0950-9240
Statut éditorial
Publié
Date de publication
08/2017
Peer-reviewed
Oui
Volume
31
Numéro
8
Pages
501-510
Langue
anglais
Notes
Publication types: Journal Article ; Review
Publication Status: ppublish
Résumé
Hypertension is a serious public health concern with inadequate control of blood pressure (BP) worldwide. Contributing factors include low efficacy of drugs, underuse of combination therapies, irrational combinations, physicians' therapeutic inertia and poor adherence to treatment. Current guidelines recommend the use of initial (dual) combination therapy in high-risk patients for immediate BP response, better short- and long-term BP control, and continued/improved patient adherence. This article aims to review the existing evidence of triple-combination therapies with respect to efficacy, safety and adherence to treatment. It is estimated that three drugs are required to achieve BP control in approximately one-fourth to one-third of patients. Randomised controlled trials (RCTs) have shown that triple combinations of amlodipine/valsartan/hydrochlorothiazide, amlodipine/olmesartan/hydrochlorothiazide and amlodipine/telmisartan/hydrochlorothiazide produce greater BP reductions, with greater proportions of patients achieving BP control compared with dual therapies. Further evidence also demonstrates that triple-combination therapy is efficacious for moderate to severe hypertension, with substantial additional BP reduction over dual regimens. Both RCTs and post-marketing observational studies have shown consistent and comparable efficacy in both the general population and high-risk hypertensive subgroups. Triple therapies are generally well tolerated with adverse event profiles similar to dual regimens. In addition, fixed-dose combinations used as single pill improve patient adherence leading to better long-term BP control. Depending on regional circumstances, they may also be cost effective. Thus, single-pill triple combinations of different classes of drugs with complementary mechanisms of action help to treat patients to goal with improved efficacy and better adherence to treatment.

Mots-clé
Antihypertensive Agents/adverse effects, Antihypertensive Agents/therapeutic use, Blood Pressure/drug effects, Drug Combinations, Drug Therapy, Combination, Humans, Hypertension/diagnosis, Hypertension/drug therapy, Hypertension/epidemiology, Hypertension/physiopathology, Medication Adherence, Risk Factors, Treatment Outcome
Pubmed
Web of science
Création de la notice
07/03/2017 21:37
Dernière modification de la notice
19/04/2018 20:54
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