It was the 2018 European Society of Cardiology/European Society of Hypertension Guidelines for the management of arterial hypertension that incited the need for evidence supporting the use of single-pill combination (SPC) treatment over free-dosed therapy for the management of hypertension.

The present systematic rapid evidence assessment was performed to ascertain if starting SPC therapy improves adherence, blood pressure (BP) control and/or cardiovascular outcomes in comparison with initiating free-dose combination therapy.

This rapid evidence assessment was done in MEDLINE, EMBASE, and Cochrane Library, from January 1, 2013 to January 11, 2019, to identify studies investigating SPC therapy for adults with hypertension. Information was obtained on adherence/persistence, BP lowering/goal attainment, and cardiovascular outcomes/events by means of a two-phase screening process.

From a total of 863 citations, 752 did not meet the inclusion criteria or were duplicates. Twenty-nine studies were obtained following full-text screening. Four of these studies (14%) were randomized controlled trials while 25 (86%) were observational studies.

An array of SPC therapies were studied, calcium channel blocker/angiotensin receptor blocker combinations being the commonest (11/29 studies). Adherence and persistence appeared to be higher with SPC compared to free-dose combination therapy. Patients who achieved BP targets varied between 25% and 89%. While all studies investigated patients with hypertension, 16 (55%) reported change in BP. Few studies reported on cardiovascular outcomes.

The investigators concluded that adherence and/or persistence were higher in patients given antihypertensive drugs as SPC, compared to free-dose combination.

Source: Tsioufis K, Kreutz R, Sykara G, et al. Impact of Single-Pill Combination Therapy on Adherence, Blood Pressure Control, and Clinical Outcomes: A Rapid Evidence Assessment of Recent Literature. J Hypertens. 2020 Jun;38(6):1016-1028.