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Combined approach for the treatment of hypertension and dyslipidemia: the case of the polypill

In cardiovascular disease (CVD) prevention, a number of medications are used long term. These include antiplatelet agents, b-blockers, angiotensin-converting nzyme (ACE) inhibitors, other blood pressure (BP)-lowering agents, and statins. All are clearly proven to reduce mortality and recurrent events and so are recommended for routine use. The benefits of these drugs have been proven in secondary prevention and among those with elevated BP or with diabetes. However, many patients with indications for such therapies are either not prescribed these medications or are unwilling to use these agents long term, either singly or in combination. It is easier for physicians to prescribe a single pill that contains several effective compounds and easier for patients to adhere to such combination-pill therapy, as compared with taking several pills daily. It would be expected that a combination pill (otherwise called a polypill) would be as effective as using each of the components separately. Two papers published over 15 years ago introduced the concept of the polypill. One posited the idea that the collective effects of taking these four agents, each of which has been proven in clinical trials to reduce the risk of CVD by about 20% to 25% in individuals with previous CVD, would lead to a large reduction in CVD (eg, by 75% to 80%).1 A second series of papers elegantly argued that a polypill with a combination of several low-dose BP-lowering agents combined with a statin (and aspirin and folate; these two have no clear proof of evidence in primary prevention although aspirin clearly works in secondary prevention) could also reduce CVD in primary prevention by up to 80% when used widely in a population over 55 years of age.

Medicographia n°140

Combined approach for the treatment of hypertension and dyslipidemia