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REFLECTIONS
Hypertension
Hypertension Global Newsletter #5 2023

The authors comment that despite the concept of SPC being
recommended in many hypertension guidelines, it is not CLINICAL PEARLS FROM THE FACULTY Hypertension
routinely implemented in clinical practice. They conclude that the
results of this study should be interpreted as a call to action to
overcome therapeutic inertia and provide patients with adequate
guideline-based therapy.

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PROF. LAURENT DISCUSS THE
CLINICAL RELEVANCE OF THE
START-STUDY TO CLINICAL PRACTICE.

Adherence and related cardiovascular outcomes to single pill vs. separate pill
administration of antihypertensive triple-combination therapy.

Rea F, et al. J Hypertens. 2023 Sep 1;41(9):1466-1473.
While several studies that have looked at the improvement of adherence in patients taking a single-pill combination (SPC) of
two BP-lowering drugs compared to separate drug administration, this study focused on whether adherence was improved in
patients taking SPC of three drugs compared to those taking a two-drug SPC plus a third agent given separately.

Using the healthcare utilisation database of the
Lombardy Region, in Italy, the authors examined
the records of 28,210 patients, aged at least 40
years, who were prescribed a three-drug SPC of
perindopril/ amlodipine/ indapamide (P/A/I) vs.
those prescribed a two-drug SPC plus a third
drug given separately (combination of an ACEi,
a calcium channel blocker [CCB], and a diuretic).
The ACEI, CCB, and diuretic were other than
perindopril, amlodipine, and indapamide in 85,
52, and 99% of the patients, respectively.

Adherence was assessed over the year after the
index date as the proportion of the follow-up days
covered by prescription (PDC). Patients who had
a PDC >75% were defined as highly adherent to
drug therapy.

High adherence to treatment was observed
in 59% of patients under three-drug SPC and
in 25% of those under three-drug, two-pill
combination. Compared with patients using a
three-drug two-pill combination, those who were
treated with the three-drug SPC had a higher

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