Issues in blood pressure control and the potential role of single-pill combination therapies


  • Disclosures
    Development of this manuscript was sponsored by Novartis Pharma AG. Michel Burnier has not received an honorarium to author this manuscript. Ruth Brown is an employee of United BioSource. As a research organisation, United BioSource conducted the original literature review upon which this article is based. United BioSource has undertaken similar projects for other pharmaceutical companies. Siew Hwa Ong and Abdulkadir Keskinaslan are directly employed by Novartis Pharma AG, and Zeba M. Khan was directly employed by Novartis Pharmaceuticals Corporation during the development of this article. Editorial support was provided by Rx Communications Limited.

Michel Burnier,
Head of Division of Nephrology and Hypertension Consultation, CHUV, Rue du Bugnon 17, 1011 Lausanne, Switzerland
Tel.: + 41 21 314 11 54
Fax: + 41 21 314 11 39


Hypertension (HTN) is a major risk factor for cardiovascular mortality, yet only a small proportion of hypertensive individuals receive appropriate therapy and achieve target blood pressure (BP) values. Factors influencing the success of antihypertensive therapy include physicians’ acceptance of guideline BP targets, the efficacy and tolerability of the drug regimen, and patient compliance and persistence with therapy. It is now well recognised that most hypertensive patients require at least two antihypertensive agents to achieve their target BP. However, complicated treatment regimens are a major contributory factor to poor patient compliance. The use of combination therapy for HTN offers a number of advantages over the use of monotherapy, including improved efficacy, as drug combinations with a synergistic mechanism of action can be used. This additive effect means that lower doses of the individual components can be used, which may translate into a decreased likelihood of adverse events. The use of single-pill combination therapy, in which two or more agents are combined in a single dosage form, offers all the benefits of free combination therapy (improved efficacy and tolerability over monotherapy) together with the added benefit of improved patient compliance because of the simplified treatment regimen. The use of single-pill combination therapy may also be associated with cost savings compared with the use of free combinations for reasons of cheaper drug costs, fewer physician visits and fewer hospitalisations for uncontrolled HTN and cardiovascular events. Thus, the use of single-pill combination therapy for HTN should help improve BP goal attainment through improved patient compliance, leading to reduced costs for cardiovascular-related care.