Jaejin An1, Catherine G Derington2, Tiffany Luong3, Kari L Olson4,5, Jordan B King2,6, Adam P Bress2, Cynthia A Jackevicius7,8,9,10,11. 1. Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave #2, Pasadena, CA, 91101, USA. jaejin.x.an@kp.org. 2. Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA. 3. Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave #2, Pasadena, CA, 91101, USA. 4. National Pharmacy Department, Kaiser Permanente Colorado, Aurora, CO, USA. 5. University of Colorado, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA. 6. Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA. 7. Department of Pharmacy Practice and Administration, Western University of Health Sciences, Pomona, CA, USA. 8. Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA. 9. Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada. 10. ICES, Toronto, Ontario, Canada. 11. University Health Network, Toronto, Ontario, Canada.
Abstract
PURPOSE OF REVIEW: To summarize the recent evidence on the effectiveness and safety of antihypertensive fixed-dose combination (FDC) medications, and to describe the facilitators and barriers to implementing FDCs in US clinical practice. RECENT FINDINGS: Recent clinical practice guidelines include FDC use for treating high BP. Clinical trials in recent years support the use of antihypertensive FDCs including low-dose triple- and quadruple-therapy FDCs. Initiating a low-to-standard dose dual-therapy FDCs showed better BP control than initiating treatment with a standard-dose monotherapy, and triple-therapy FDCs produced better BP control rates than dual-therapy FDCs. Retrospective cohort studies showed that FDCs are associated with increased medication adherence, reduced clinical inertia, decreased time to BP control, and improved cardiovascular outcomes. We further discussed barriers and facilitators of wider implementation of antihypertensive FDCs in clinical practice. FDC treatment for hypertension is not commonly used despite historical and recent data which support the effectiveness, safety, and benefits of FDCs. Simplified and protocolized treatment algorithms, team-based care, shared decision-making principles are crucial to successful utilization and implementation of FDC in clinical practice.
PURPOSE OF REVIEW: To summarize the recent evidence on the effectiveness and safety of antihypertensive fixed-dose combination (FDC) medications, and to describe the facilitators and barriers to implementing FDCs in US clinical practice. RECENT FINDINGS: Recent clinical practice guidelines include FDC use for treating high BP. Clinical trials in recent years support the use of antihypertensive FDCs including low-dose triple- and quadruple-therapy FDCs. Initiating a low-to-standard dose dual-therapy FDCs showed better BP control than initiating treatment with a standard-dose monotherapy, and triple-therapy FDCs produced better BP control rates than dual-therapy FDCs. Retrospective cohort studies showed that FDCs are associated with increased medication adherence, reduced clinical inertia, decreased time to BP control, and improved cardiovascular outcomes. We further discussed barriers and facilitators of wider implementation of antihypertensive FDCs in clinical practice. FDC treatment for hypertension is not commonly used despite historical and recent data which support the effectiveness, safety, and benefits of FDCs. Simplified and protocolized treatment algorithms, team-based care, shared decision-making principles are crucial to successful utilization and implementation of FDC in clinical practice.
Authors: Álvaro Sosa Liprandi; Adrián Baranchuk; Ricardo López-Santi; Fernando Wyss; Daniel Piskorz; Adriana Puente; Carlos I Ponte-Negretti; Ana Muñera-Echeverri; Daniel José Piñeiro Journal: Rev Panam Salud Publica Date: 2022-09-16