The Role of the Polypill in Hypertension
Cardiovascular diseases (CVD) continue to occur in epidemic proportions globally. Any epidemic requires multiple strategies and the mobilization of a large number of individuals to contain and reverse it, so that the burden on mortality and morbidity can
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Andrew Mente, Prem Pais, Denis Xavier, Koon Teo and Salim Yusuf
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Introduction
Cardiovascular diseases (CVD) continue to occur in epidemic proportions globally. Any epidemic requires multiple strategies and the mobilization of a large number of individuals to contain and reverse it, so that the burden on mortality and morbidity can be substantially reduced. At present, hypertension is the most common modifiable cause of disease globally and accounts for about 8 % of all global deaths. Hypertension occurs in about 40 % of the adult population in most countries and in nearly 60 % of all individuals who are destined to have a cardiovascular event. Incremental increases in blood pressure (BP) confer an increasing and graded risk. Randomized controlled trials (RCTs) have demonstrated that greater degrees of BP lowering in those with hypertension will lead to greater risk reductions in stroke and coronary heart disease (CHD). The challenge with hypertension control is fourfold: (1) diagnosis through screening because it is silent in most individuals; (2) initiation of treatment in the majority of individuals; (3) rapid achievement of optimal BP lowering; (4) and enhancing long-term treatment adherence. There are extensive guidelines for controlling hypertension in most countries in the world and inexpensive, generic BP-lowering drugs such as diuretics and beta-blockers, and angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers are widely available.
A. Mente P. Pais D. Xavier K. Teo Population Health Research Institute, Hamilton Health Sciences and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada e-mail: [email protected] S. Yusuf (&) McMaster University, Faculty of Health Sciences, Hamilton Health Sciences Corporation, McMaster Clinic, Hamilton, Canada e-mail: [email protected] A. E. Berbari and G. Mancia (eds.), Special Issues in Hypertension, DOI: 10.1007/978-88-470-2601-8_22, Ó Springer-Verlag Italia 2012
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Despite this, there is a huge treatment gap and the majority of individuals with hypertension in most countries are not detected, poorly treated, and not controlled. In general, only half of those with hypertension in the population are detected, but once detected about 60–70 % of individuals are treated. However, in the majority BP control is poor with only about 10–20 % of those with hypertension achieving adequate control [unpublished data from the Prospective Urban Rural Epidemiology (PURE) study]. Therefore the two major gaps in the management of hypertension are a lack of a systematic approach to screening of the adult population and the use of simple, low-cost, and effective BP-lowering therapies. The control of high BP is rarely achieved using single BP-lowering drugs. Therefore, in most individuals (especially those with multiple concomitant risk factors such as diabetes or obesity or those with established CVD), it requires the use of two or more effective antihypertensive medications. The benefits of a two
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