Triple Combinacion

Patient Preference and Adherence

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Three in one: safety, efficacy, and patient
acceptability of triple fixed-dose combination
medicine in the management of hypertension
This article was published in the following Dove Press journal:
Patient Preference and Adherence
31 July 2012
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Addison A Taylor
Shawn Ragbir
Department of Medicine, Baylor
C ollege of Medicine, Houston,
T X, USA

Abstract: Hypertensive patients whose blood pressures are more than 20 mmHg above their
goal will often require three or more medications. Careful selection of medications whose
actions are complementary or have an improved adverse effect profile whencombined can
affect not only the blood pressure but also patient acceptance, thus improving persistence in
taking the medications as prescribed. This review will highlight the three single-pill three-drug
combinations currently available in the US and will address their efficacy, safety, and tolerability.
All three include the dihydropyridine calcium-channel blocker, amlodipine, and thethiazide
diuretic, hydrochlorothiazide. They each contain a different renin–angiotensin system blocker.
One includes the angiotensin-receptor blocker, olmesartan, while another contains valsartan.
The third combination includes the direct renin inhibitor, aliskiren. All three fixed-dose combinations (FDC) at maximum doses of each component lowers the blood pressure of patients
with stage IIhypertension by 37 to 40 mmHg systolic and 21 to 25 mmHg diastolic, which
is superior to any two of the components that comprise the three-drug FDC. These drugs are
effective in males and females, the elderly, diabetics, minority populations, and patients with
metabolic syndrome. Triple-drug FDCs are well tolerated with a low incidence of adverse
effects, the most common being peripheral edemarelated to amlodipine. Extrapolation of data
from two-drug FDC suggests that medication compliance (adherence and persistence) should
be better with these FDCs than with the individual components taken as separate medications,
although additional studies are necessary to confirm this.
Keywords: calcium-channel blockers, hypertension, patient tolerability, renin–angiotensin
system antagonists,safety, triple-drug combinations

Introduction

Correspondence: Addison A Taylor
Department of Medicine, Baylor College
of Medicine, 1709 Dryden Road, Suite
600, MS620, Houston, TX 77030, USA
Email ataylor@bcm.edu

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Dovepress
http://dx.doi.org/10.2147/PPA.S14764

Hypertension is the most prevalent modifiable risk factor for cardiovascular andcerebrovascular morbidity and mortality. An estimated 30% of the adult population in the
United States has hypertension,1 and a similar prevalence worldwide represents a global
health problem.2 The risk of a cardiovascular or cerebrovascular event is closely linked
to the magnitude of blood pressure (BP) increase3 and is exaggerated at any level of
blood pressure in individuals who also havediabetes mellitus, chronic kidney disease,
or coronary artery disease.4–9 A higher BP at the time of diagnosis indicates that he or
she is more likely to require two or more drugs to achieve BP control. More drugs will
likely be required for individuals with coronary artery disease, chronic kidney disease,
or diabetes for whom goals lower than 140/90 mmHg have been recommended.6,10
Furthermore,there is growing evidence from randomized clinical trials such as
VALUE (Valsartan Antihypertensive Long-Term Use Evaluation),11 Syst-Eur (Systolic

Patient Preference and Adherence 2012:6 555–563
555
© 2012 Taylor and Ragbir, publisher and licensee Dove Medical Press Ltd. This is an Open Access article
which permits unrestricted noncommercial use, provided the original work is properly...