Blood Pressure Lowering Combination Preparations

At the congress of the European Society of Cardiology (ESC) at the end of August 2018 in Munich, the new guideline for the pharmacological treatment of hypertension was presented.

Until now, patients with hypertension were usually prescribed a medication against high blood pressure consisting of one or more different active ingredients. The new guideline now considers combination preparations as standard therapy, which contain two or three combined active ingredients.

These offer many advantages:

Taking fewer tablets
lower amount of active ingredients
better blood pressure reduction
fewer side effects
greater treatment adherence

Blood Pressure Lowering Combination Preparations

Through therapy with combination preparations, an improvement in the situation is hoped for in multiple ways. First and foremost, taking medication is made easier for the patient when they only have to take one tablet against high blood pressure instead of two or three different ones. This tablet already contains the active ingredients of the previously taken two or three different medications or can replace them with a suitable combination. Additionally, combination preparations often come with a lower amount of active ingredients, which reduces the risk of side effects. This is also intended to increase treatment adherence and reduce the occurrence of secondary diseases.

A study published in April 2023 demonstrated that combination preparations can also be an alternative therapy for newly or relatively newly diagnosed hypertension.

Because treatment adherence (as observed) decreases with the increasing number of tablets to be taken. The more tablets a person is supposed to take, the less willing they often are to do so. The risk of forgetting a medication or making errors in the composition of the "portions" of the medications to be taken increases with the number of tablets listed on the medication plan.
However, if blood pressure medications are not taken as prescribed, it can have fatal consequences. Heart attack, stroke, and sudden cardiac death are the most serious consequences that can arise from a therapy plan that is not followed or only partially followed. High blood pressure can also cause damage in many other places in the body - for example, to the kidneys or the eyes. In addition to reduced quality of life, these secondary diseases also incur high treatment costs.

A study published in August 2024 from Nigeria also demonstrated better blood pressure reduction among participants taking a 3-in-1 preparation compared to medication with single active ingredients. Blood pressure decreased more quickly and more significantly with the combination preparation.

At the ESC Congress 2024, a study was presented that examined the effect of a 4-fold combination for patients who could not achieve sufficient blood pressure reduction with a 3-fold pill. This showed improved blood pressure reduction in the group that received an additional active ingredient. Here, blood pressure fell below 140/90 mmHg in over 66% of participants. In the comparison group, which continued to take the 3-fold combination, this was only achieved in 42%. The researchers thus demonstrate the superiority of a 4-fold combined tablet for people with treatment-resistant or difficult-to-control hypertension.

Although this change in the guideline initially increases costs for health insurance companies, as combination preparations are usually more expensive than single active ingredients, the high costs for the treatment of secondary diseases decrease in the long run.

A study published in Clinical Research in Cardiology examined the frequency of prescriptions for combination preparations from 2016 to 2020. It concluded that, despite the adjustment of the guidelines in 2018, they account for a small proportion of the number of prescribed hypertension medications.

Source:

By Dr. med. Christine Berchtold-Benchieb. This article is medically reviewed. Last updated by Sabine Croci (09/2024).
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We hope you found the article on the topic helpful. For good blood pressure management, it is important to take the medications correctly. Our app BloodPressureDB is happy to remind you of the intake times. It also manages the supply and informs you in good time when it is running low. This feature is also fully available in the free version. Get the free app now.

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Blood Pressure Lowering Combination Preparations

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