Clinical Trial Registration Number: ISRCTN43076122.
A pilot double-blind randomised placebo-controlled trial of the effects of fixed-dose combination therapy (‘polypill’) on cardiovascular risk factors
Article first published online: 13 JUL 2010
© 2010 Blackwell Publishing Ltd
International Journal of Clinical Practice
Volume 64, Issue 9, pages 1220–1227, August 2010
How to Cite
Malekzadeh, F., Marshall, T., Pourshams, A., Gharravi, M., Aslani, A., Nateghi, A., Rastegarpanah, M., Khoshnia, M., Semnani, S., Salahi, R., Thomas, G. N., Larijani, B., Cheng, K. K. and Malekzadeh, R. (2010), A pilot double-blind randomised placebo-controlled trial of the effects of fixed-dose combination therapy (‘polypill’) on cardiovascular risk factors. International Journal of Clinical Practice, 64: 1220–1227. doi: 10.1111/j.1742-1241.2010.02412.x
Disclosures All authors declare that they have no conflicts of interest in relation to this study.
- Issue published online: 13 JUL 2010
- Article first published online: 13 JUL 2010
- Paper received January 2010, accepted March 2010
Aim: Our objective was to investigate the effects and tolerability of fixed-dose combination therapy on blood pressure and LDL in adults without elevated blood pressure or lipid levels.
Methods: This was a double-blind randomised placebo-controlled trial in residents of Kalaleh, Golestan, Iran. Following an 8-week placebo run-in period, 475 participants, aged 50 to 79 years, without cardiovascular disease, hypertension or hyperlipidaemia were randomised to fixed-dose combination therapy with aspirin 81 mg, enalapril 2.5 mg, atorvastatin 20 mg and hydrochlorothiazide 12.5 mg (polypill) or placebo for a period of 12 months. The primary outcomes were changes in LDL-cholesterol, systolic and diastolic blood pressure and adverse reactions. Analysis was by intention-to-treat basis.
Results: At baseline, there were differences in systolic blood pressure (6 mmHg). Taking account of baseline differences, at 12 months, polypill was associated with statistically significant reductions in blood pressure (4.5/1.6 mmHg) and LDL-cholesterol (0.46 mmol/l). The study drug was well tolerated, but resulted in the modest reductions in blood pressure and lipid levels.
Conclusion: The effects of the polypill on blood pressure and lipid levels were less than anticipated, raising questions about the reliability of the reported compliance. There is a case for a fully powered trial of a polypill for the prevention of cardiovascular disease.