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Efficacy of Single-Pill, Triple Antihypertensive Therapy in Patients with Uncontrolled Hypertension: A Systematic Review and Meta-analysis

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Abstract

Introduction

Systemic arterial hypertension is the most common preventable risk factor for all causes of morbidity and mortality worldwide with a prevalence of 35–40% of the adults. Despite the wide variety of effective antihypertensive medications, most hypertensive patients remain uncontrolled. However, the combination of ACE inhibitor, diuretics, and calcium antagonist for the triple therapy in a single Pill Combination (SPC) is an efficient regimen in hypertension management. It is recommended by the ESH 2018 guideline, which offers better efficacy and compliance to treatment.

Aim

To evaluate the efficacy of perindopril/indapamide/amlodipine single-pill combination in patients with uncontrolled hypertension.

Methods

We searched PubMed, Scopus, Web of Science, and Cochrane CENTRAL for relevant clinical trials. We conducted the risk of bias assessment using Cochrane’s risk of bias tool. We performed the analysis of continuous data using mean difference (MD) and relative 95% confidence interval (CI), while dichotomous data were analyzed using risk ratio (RR) and relative 95% CI. We included the analysis of the following outcomes: systolic blood pressure (SBP), Diastolic blood pressure (DBP), Heart rate (HR), 24 h Ambulatory blood pressure monitoring (ABPM) for SBP, and 24 h ABPM for DBP.

Results

We included six clinical trials. We found that the triple therapy significantly reduces SBP by 24 mmHg (MD = − 24.65 [22.41, 26.89], (P < 0.01)), DBP by 12 mmHg (MD = 12.41 [11.53, 13.29], (P < 0.01)), 24-h ABPM for SBP by 14 mmHg (MD = 14.08 [9.10, 19.05], (P < 0.01)), and ABPM 24 h DBP by 7 mmHg (MD = 7.01 [5.37, 8.65], (P < 0.01)). We noted no significant difference of the single pill on heart rate (MD = 0.81 [− 0.04, 1.67], (P = 0.06).

Conclusion

perindopril/indapamide/amlodipine is effective in reducing systolic and diastolic blood pressures by 24 and 12 mmHg respectively. Over 24 h, the combination reduced systolic and diastolic blood pressures by 14 and 7 mmHg respectively.

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Data availability

All data generated or analyzed during this study are included in this manuscript and its supplementary files. Further inquiries can be directed to the corresponding author.

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Funding

This study has not received any external funding.

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Authors and Affiliations

  1. School of Medicine, Jordan University, Amman, Jordan

    Shady Habboush & Omar Cherfaoui

  2. Faculty of medicine, Fayoum University, Fayoum, Egypt

    Ahmed Adel Sofy, Ahmed Taher Masoud, Abdullah Mohamed Farhat & Ahmed Taha Abdelsattar

  3. Department of Internal Medicine, College of Medicine, University of Kentucky, 800 Rose St, Lexington, KY, 40508, USA

    Ahmed Elmoursi

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  1. Shady Habboush
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  2. Ahmed Adel Sofy
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Correspondence to Ahmed Elmoursi.

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The ethics statement is not applicable because this study is based exclusively on published literature.

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Habboush, S., Sofy, A.A., Masoud, A.T. et al. Efficacy of Single-Pill, Triple Antihypertensive Therapy in Patients with Uncontrolled Hypertension: A Systematic Review and Meta-analysis. High Blood Press Cardiovasc Prev 29, 245–252 (2022). https://doi.org/10.1007/s40292-022-00511-y

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