Document Detail

Combining antihypertensive and antihyperlipidemic agents - optimizing cardiovascular risk factor management.
MedLine Citation:
PMID:  22162939     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Clinical guidelines now recognize the importance of a multifactorial approach to managing cardiovascular (CV) risk. This idea was taken a step further with the concept of the Polypill™. There are, however, considerable patent, pharmacokinetic, pharmacodynamic, registration, and cost implications that will need to be overcome before the Polypill™ or other single-pill combinations of CV medications become widely available. However, a medication targeting blood pressure (BP) and lipids provides much of the proposed benefits of the Polypill™. A single-pill combination of the antihypertensive amlodipine besylate and the lipid-lowering medication atorvastatin calcium (SPAA) is currently available in many parts of the world. This review describes the rationale for this combination therapy and the clinical trials that have demonstrated that these two agents can be combined without the loss of efficacy for either agent or an increase in the incidence of adverse events. The recently completed Cluster Randomized Usual Care vs Caduet Investigation Assessing Long-term-risk (CRUCIAL trial) is discussed in detail. CRUCIAL was a 12-month, international, multicenter, prospective, open-label, parallel design, cluster-randomized trial, which demonstrated that a proactive intervention strategy based on SPAA in addition to usual care (UC) had substantial benefits on estimated CV risk, BP, and lipids over continued UC alone. Adherence with antihypertensive and lipid-lowering therapies outside of the controlled environment of clinical trials is very low (~30%-40% at 12 months). Observational studies have demonstrated that improving adherence to lipid-lowering and antihypertensive medications may reduce CV events. One means of improving adherence is the use of single-pill combinations. Real-world observational studies have demonstrated that patients are more adherent to SPAA than co-administered antihypertensive and lipid-lowering therapy, and this improved adherence translated to reduced CV events. Taken together, these findings suggest that SPAA can play an important role in helping physicians improve the management of CV risk in their patients.
José Zamorano; Jonathan Edwards
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Publication Detail:
Type:  Journal Article     Date:  2011-11-15
Journal Detail:
Title:  Integrated blood pressure control     Volume:  4     ISSN:  1178-7104     ISO Abbreviation:  Integr Blood Press Control     Publication Date:  2011  
Date Detail:
Created Date:  2011-12-14     Completed Date:  2012-10-02     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  101562709     Medline TA:  Integr Blood Press Control     Country:  New Zealand    
Other Details:
Languages:  eng     Pagination:  55-71     Citation Subset:  -    
Hospital Clinico San Carlos, Madrid, Spain.
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