Personalised Single-Pill Combination Therapy in Hypertensive Patients: An Update of a Practical Treatment Platform
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POSITION PAPER
Personalised Single-Pill Combination Therapy in Hypertensive Patients: An Update of a Practical Treatment Platform Massimo Volpe1,2 • Giuliano Tocci1,2 • Alejandro de la Sierra3 • Reinhold Kreutz4,5,6,7 Ste´phane Laurent8 • Athanasios J. Manolis9 • Kostantinos Tsioufis10
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Received: 6 September 2017 / Accepted: 2 October 2017 Ó The Author(s) 2017. This article is an open access publication
Abstract Despite the improvements in the management of hypertension during the last three decades, it continues to be one of the leading causes of cardiovascular morbidity and mortality worldwide. Effective and sustained reductions in blood pressure (BP) reduce the incidence of myocardial infarction, stroke, congestive heart failure and cardiovascular death. However, the proportion of patients who achieve the recommended BP goal (\ 140/90 mmHg) is persistently low, worldwide. Poor adherence to therapy, complex therapeutic regimens, clinical inertia, drug-related adverse events and multiple risk factors or comorbidities contribute to the disparity between the potential and actual BP control rate. Previously we published a practical therapeutic platform for the treatment of hypertension based on clinical evidence, guidelines, best practice and clinical experience. This platform provides a personalised treatment approach and can be used to improve BP control and
simplify treatment. It uses long-acting, effective and welltolerated angiotensin receptor blocker (ARB) olmesartan, in combination with a calcium channel blocker amlodipine, and/or a thiazide diuretic hydrochlorothiazide. These drugs were selected based on the availability in most European Countries of single-pill, fixed formulations in a wide range of doses for both dual- and triple-drug combinations. The platform approach could be applied to other ARBs or angiotensin-converting enzyme inhibitors available in single-pill, fixed-dose combinations. Here, we present an update, which takes into account the results of the recently published studies and extends the applicability of the platform to common conditions that are often neglected or poorly considered in clinical practice guidelines. Keywords Antihypertensive therapy Angiotensin receptor blockers Angiotensin-converting enzyme inhibitors Calcium channel blockers Hypertension Olmesartan medoxomil
Electronic supplementary material The online version of this article (doi:10.1007/s40292-017-0239-7) contains supplementary material, which is available to authorized users. & Massimo Volpe [email protected] 1
Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sant’Andrea Hospital, University of Rome Sapienza, Via di Grottarossa 1035-39, 00189 Rome, Italy
2
IRCCS Neuromed, Via Atinense, 18, 86077 Pozzilli, Isernia, Italy
3
Department of Internal Medicine, Hospital Mu´tua Terrassa, University of Barcelona, Plac¸a del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain
4
Department of Clinical Pharmacology and Toxicology, Charite´,
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