Taking one daily pill that combined medications to treat high blood pressure and high cholesterol lowered heart disease risk among underserved patients better than taking several separate medications to treat these risk factors, according to new research published in The New England Journal of Medicine. Researchers found that patients were also likely to stick to a medication routine if they only had one pill to take.
“Patients face a variety of barriers to getting the care they need,” said study author Daniel Muñoz, MD, Assistant Professor of Cardiology at Vanderbilt University Medical Center in Nashville, Tennessee. “Those barriers can include cost and complexity of medication regimens, so innovative strategies are needed to improve the delivery of preventive care, especially when it comes to socio-economically vulnerable individuals.”
Dr. Muñoz and colleagues studied how a polypill including four medicines known to lower high blood pressure and low-density lipoprotein (LDL) cholesterol would affect patients with high blood pressure and high cholesterol at a community health center in Mobile, Alabama. Three-quarters of the 303 patients studied reported making less than $15,000 a year; 96% were black; 60% were women; and the average age was 56.
Half the patients were given a daily polypill that contained four low-dose medications: atorvastatin (10 mg), amlodipine (2.5 mg), losartan (25 mg), and hydrochlorothiazide (12.5 mg). The other patients received their usual medical care and medications. Clinicians conducted a medical exam and measured patients’ blood pressure and blood cholesterol at the study’s start, at two months, and at one year.
Patients taking the polypill had higher reductions in systolic blood pressure and LDL cholesterol compared to those in the usual care group. In the polypill group, systolic blood pressure fell an average 9 mm Hg, compared with 2 mm Hg by one year in the usual care group. LDL cholesterol fell an average of 15 mg/dL in the polypill group versus 4 mg/dL in the usual care group. These differences translate to about a 25% reduction in the risk of experiencing a cardiovascular event, such as a heart attack.
Medication adherence over the 12-month study period was high (86%) in patients assigned to the polypill group, compared to past studies that found fewer than half of patients are still on their prescribed blood pressure medicines at one year.
Source: American Heart Association, September 19, 2019