Single-Pill Combination versus Single-Agent Pills Treatment in Patients with Hypertension: An Overview of Reviews - Abstract
Introduction: Treatment with a single-pill combination (SPC) as compared to two or more single-agent pill (SAP) antihypertensive agents reduces pill burden potentially
improving outcomes in patients with hypertension.
Aim: This overview of reviews summarized the evidence from systematic reviews (SRs) comparing SPC and SAP antihypertensive therapy to support the development of the
World Health Organization guideline.
Methods: We searched Medline, Embase, and the Cochrane databases from January 1st, 2015, through May 29th, 2020, to identify SRs comparing SPC to SAP antihypertensive
therapy. We screened eligible reviews and abstracted data, in duplicate. We assessed the quality of the reviews using the Assessing the Methodological Quality of Systematic
Reviews (AMSTAR) tool and the certainty of the evidence using the Grading of Recommendations Assessments, Development, and Evaluation (GRADE) approach.
Results: We screened 3,229 records and included three SRs that summarized data from 31 studies. Antihypertensive pharmacotherapy with SPCs as compared to SAPs
increased adherence to treatment as assessed by a medicine possession ratio (MPR) >0.8 (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.23 to 1.74, and by the proportion
of days covered (PDC) >0.80 (OR 2.25, 95% CI 1.09 to 4.64), increased treatment-related adverse events (risk ratio [RR] 1.13 (95%CI 0.85 to 1.50), and improved BP control (RR
1.11 (95%CI 0.92 to 1.33), all with low certainty. There was no evidence for other important patient outcomes.
Conclusion: While adherence and blood pressure control to antihypertensive medications may be better in patients treated with SPCs compared with SAPs, treatment-related
adverse events may increase.