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Restoring the upward trend in blood pressure control rates in the United States: a focus on fixed-dose combinations

Journal of Human Hypertension volume 34, pages 617–623 (2020)Cite this article

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Between 1988 and 2008, BP control rates (defined as systolic/diastolic BP < 140/90 mm Hg) steadily increased from 47% to 69% among US adults with hypertension taking antihypertensive medication [1, 2]. However, this upward trend has since stagnated at around 70% [3, 4]. The reasons for this plateau are complex, multifactorial, and likely interrelated. For example, therapeutic inertia, rising obesity rates, high healthcare costs, inequities in access to healthcare, poor dietary choices, and declining rates of physical activity likely all contribute. Despite these pressures, several integrated healthcare systems have successfully increased their BP control rates to >80% with multimodal interventions including patient registries, simplified treatment algorithms, and team-based care [5, 6]. One part of the success of these programs may be the increased use of fixed-dose combination (FDC) antihypertensive medication products, which reduce daily pill burden and improve adherence [7]. Herein, we review the current landscape and potential for FDCs in the management of hypertension in the US.

Most patients require two or more antihypertensive medication classes to achieve adequate BP control. Monotherapy may only be successful in 10–33% of patients, perhaps even less with the more intensive BP goals recommended by the 2017 American College of Cardiology/American Heart Association guidelines [8]. Accordingly, data from the Systolic Blood Pressure Intervention Trial (SPRINT) suggest that nearly all patients (87%) require at least two antihypertensive classes to achieve more intensive systolic BP goals (systolic BP < 120 mm Hg) [9]. This is consistent with data from a meta-analysis of randomized trials showing the superior BP-lowering effect of combination therapy over monotherapy, with an equivalent safety profile [10].

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Fig. 1: Antihypertensive regimens that are lower cost when prescribed as a fixed-dose combination pill or free-equivalent products.

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Funding

APB is supported by K01HL133468 from the National Heart, Lung, and Blood Institute. CGD is supported by research funds received to her institution from Amgen, Inc. and Amarin Corporation for research unrelated to the current paper. JBC is supported by K23HL133843 from the National Heart, Lung, and Blood Institute.

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Authors and Affiliations

  1. Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA

    Catherine G. Derington & Adam P. Bress

  2. Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Jordana B. Cohen

  3. Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Jordana B. Cohen

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  1. Catherine G. Derington
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Correspondence to Catherine G. Derington.

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CGD is a past recipient of American Heart Association grant #19POST34380226/Derington/2019.

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Derington, C.G., Cohen, J.B. & Bress, A.P. Restoring the upward trend in blood pressure control rates in the United States: a focus on fixed-dose combinations. J Hum Hypertens 34, 617–623 (2020). https://doi.org/10.1038/s41371-020-0340-6

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