arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2024-2454HEZRCBarthyper-2454Research ArticleСтатьиArticlesТройные фиксированные комбинации в лечении артериальной гипертензии. Реальные преимущества в условиях клинической практикиFixed triple combinations in the treatment of arterial hypertension. Real world benefits in clinical practicehttps://orcid.org/0000-0001-8169-7812КонрадиА. О.KonradiA. O.

Конради Александра Олеговна — доктор медицинских наук, профессор, академик Российской академии наук, заведующая кафедрой организации, управления и экономики здравоохранения факультета послевузовского и дополнительного образования Института медицинского образования, заместитель генерального директора по научной работе

ул. Аккуратова, д. 2, Санкт- Петербург, 197341

Тел.: 8 (812) 702–37–33

Aleksandra O. Konradi, MD, PhD, DSc, Professor, Academician of the Russian Academy of Sciences, Head, Department of Organization, Management and Economics of Healthcare, Faculty of Postgraduate and Additional Education, Institute of Medical Education, Deputy Director General on Research

2 Akkuratov str., St Petersburg, 1, 97341

Phone: 8 (812) 702–37–33

konradi@almazovcentre.ruФедеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр имени В.А.Алмазова» Министерства здравоохранения Российской ФедерацииРоссияAlmazov National Medical Research CentreRussian Federation202404072024303318325Copyright © Конради А.О., 20242024Конради А.О.Konradi A.O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://htn.almazovcentre.ru/jour/article/view/2454

Применение фиксированных комбинаций (ФК) препаратов для снижения артериального давления уже два десятка лет считается самой эффективной стратегией в повышении приверженности к лечению и входит в стандарт назначения терапии почти во всех мировых рекомендациях, в том числе в Российской Федерации. При этом реальное использование на практике таких лекарственных форм, особенно тройных комбинаций, остается недостаточным. В обзоре приведены имеющиеся данные о преимуществах применения тройных ФК с фокусом на наиболее часто используемую комбинацию амлодипина, индапамида и периндоприла, в том числе с точки зрения влияния на прогноз, частоту госпитализаций и затраты на лечение пациента.

Fixed-dose combinations are generally believed to be the best tool to improve patients’ adherence, thus they are recommended as a first choice for drug prescription in majority of hypertension guidelines all over the world, including Russia. At the same time real world prescription rate is rather low, especially for triple combinations. The review summarizes the treatment benefits of triple antihypertension drug combination with a focus on amlodipine + indapamide + perindopril. The benefits from studies based in real world evidence for outcome, hospitalization rate and treatment costs are presented.

артериальная гипертензияфиксированные комбинации препаратовамлодипининдапамидпериндоприлhypertensionfixed combinationsamlodipinperindoprilindapamidСтатья подготовлена при информационной поддержке компании «Сервье» (Франция), что никоим образом не повлияло на мнение автора и материал статьи.The article was prepared with the informational support of the Servier company (France), which in no way affected the opinion of the author and the presented data.ReferencesGlobal report on hypertension: the race against a silent killer. Geneva: World Health Organization; 2023. Licence: CC BY-NC-SA 3.0 IGO.Global report on hypertension: the race against a silent killer. Geneva: World Health Organization; 2023. Licence: CC BY-NC-SA 3.0 IGO.World Population Prospects 2022. New York: United Nations Population Division; 2022. URL: https://population.un.org/wpp/, accessed 12 September 2023.World Population Prospects 2022. New York: United Nations Population Division; 2022. URL: https://population.un.org/wpp/, accessed 12 September 2023.Global Health Estimates 2019: deaths by cause, age, sex, by country and by region, 2000–2019. Geneva, World Health Organization; 2020. URL: https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-leading-causes-of-death, accessed 2 August 2023.Global Health Estimates 2019: deaths by cause, age, sex, by country and by region, 2000–2019. Geneva, World Health Organization; 2020. URL: https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-leading-causes-of-death, accessed 2 August 2023.NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet. 2021;398(10304):957–980. doi:10.1016/S0140-6736(21)01330-1NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. Lancet. 2021;398(10304):957–980. doi:10.1016/S0140-6736(21)01330-1Corrao G, Parodi A, Nicotra F, Zambon A, Merlino L, Cesana G et al. Better compliance to antihypertensive medications reduces cardiovascular risk. J Hypertens. 2011;29(3):610–618. doi:10.1097/HJH.0b013e328342ca97Corrao G, Parodi A, Nicotra F, Zambon A, Merlino L, Cesana G et al. Better compliance to antihypertensive medications reduces cardiovascular risk. J Hypertens. 2011;29(3):610–618. doi:10.1097/HJH.0b013e328342ca97Xu T, Yu X, Ou S, Liu X, Yuan J, Tan X et al. Adherence to antihypertensive medications and stroke risk: a dose-response meta-analysis. J Am Heart Assoc. 2017;6(7): e006371. doi:10.1161/JAHA.117.006371Xu T, Yu X, Ou S, Liu X, Yuan J, Tan X et al. Adherence to antihypertensive medications and stroke risk: a dose-response meta-analysis. J Am Heart Assoc. 2017;6(7): e006371. doi:10.1161/JAHA.117.006371Abegaz TM, Shehab A, Gebreyohannes EA, Bhagavathula AS, Elnour AA. Nonadherence to antihypertensive drugs: a systematic review and meta-analysis. Medicine (Baltimore). 2017;96(4): e5641. doi:10.1097/MD.0000000000005641Abegaz TM, Shehab A, Gebreyohannes EA, Bhagavathula AS, Elnour AA. Nonadherence to antihypertensive drugs: a systematic review and meta-analysis. Medicine (Baltimore). 2017;96(4): e5641. doi:10.1097/MD.0000000000005641Corrao G, Zambon A, Parodi A, Poluzzi E, Baldi I, Merlino L et al. Discontinuation of and changes in drug therapy for hypertension among newly-treated patients: a population-based study in Italy. J Hypertens. 2008;26(4):819–824. doi:10.1097/HJH.0b013e3282f4edd7Corrao G, Zambon A, Parodi A, Poluzzi E, Baldi I, Merlino L et al. Discontinuation of and changes in drug therapy for hypertension among newly-treated patients: a population-based study in Italy. J Hypertens. 2008;26(4):819–824. doi:10.1097/HJH.0b013e3282f4edd7Николаев Н. А., Мартынов А. И., Скирденко Ю. П., Авдеев В. Н., Анисимов В. Н., Арутюнов Г. П. и др. Приверженность лечению. Российское национальное руководство. Под общей ред. Николаева Н. А., Мартынова А. И., Скирденко Ю. П. М.: Издательский дом Академии естествознания, 2022. 224 с. ISBN 978-5-91327-746-6. doi:10.17513/np.541.Nikolaev NA, Martynov AI, Skirdenko YP, Avdeev VN, Anisimov VN, Arutyunov GP et al. Adherence to treatment. Russian national guidelines. Ed. by Nikolaev NA, Martynov AI, Skirdenko YP. M.: Publishing house of the academy of natural sciences, 2022. 224 p. ISBN: 978–5–91327–746–6. doi:10.17513/np.541. In Russian.Tsioufis K, Kreutz R, Sykara G, van Vugt J, Hassan T. Impact of single-pill combination therapy on adherence, blood pressure control, and clinical outcomes: a rapid evidence assessment of recent literature. J Hypertens. 2020;38(6):1016–1028. doi:10.1097/HJH.0000000000002381Tsioufis K, Kreutz R, Sykara G, van Vugt J, Hassan T. Impact of single-pill combination therapy on adherence, blood pressure control, and clinical outcomes: a rapid evidence assessment of recent literature. J Hypertens. 2020;38(6):1016–1028. doi:10.1097/HJH.0000000000002381Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C et al. 2017 ACC/AHA/AAPA/ ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):1269–1324. doi:10.1161/HYP.0000000000000066Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C et al. 2017 ACC/AHA/AAPA/ ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):1269–1324. doi: 10.1161/HYP.0000000000000066NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/ American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):1269–1324. doi:10.1161/HYP.0000000000000066NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/ American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71(6):1269–1324. doi:10.1161/HYP.0000000000000066Joint Committee for Guideline Revision. Chinese guidelines for prevention and treatment of hypertension — a report of the revision committee of Chinese guidelines for prevention and treatment of hypertension. J Geriatr Cardiol. 2019;16(3):182–241. doi:10.11909/j.issn.1671-5411.2019.03.014Joint Committee for Guideline Revision. Chinese guidelines for prevention and treatment of hypertension — a report of the revision committee of Chinese guidelines for prevention and treatment of hypertension. J Geriatr Cardiol. 2019;16(3):182–241. doi:10.11909/j.issn.1671-5411.2019.03.014NICE. NICE Guidelines: Hypertension in adults: diagnosis and management. 2019. Accessed April 21, 2020. URL: https://www.nice.org.uk/guidance/ng136NICE. NICE Guidelines: Hypertension in adults: diagnosis and management. 2019. Accessed April 21, 2020. URL: https://www.nice.org.uk/guidance/ng136Parati G. Adherence to single-pill versus free-equivalent combination therapy in hypertension. Hypertension. 2021;77(2):692–705. doi:10.1161/HYPERTENSIONAHA.120.15781Parati G. Adherence to single-pill versus free-equivalent combination therapy in hypertension. Hypertension. 2021;77(2):692–705. doi:10.1161/HYPERTENSIONAHA.120.15781Rea F, Corrao G, Merlino L, Mancia G. Initial antihypertensive treatment strategies and therapeutic inertia. Hypertension. 2018;72(4):846–853. doi:10.1161/HYPERTENSIONAHARea F, Corrao G, Merlino L, Mancia G. Initial antihypertensive treatment strategies and therapeutic inertia. Hypertension. 2018;72(4):846–853. doi:10.1161/HYPERTENSIONAHABorghi C, Wang J, Rodionov AV, Rosas M, Sohn IS, Alcocer L et al. Projecting the long-term benefits of single pill combination therapy for patients with hypertension in five countries. Int J Cardiol Cardiovasc Risk Prev. 2021;10:200102. doi:10.1016/j.ijcrp.2021.200102Borghi C, Wang J, Rodionov AV, Rosas M, Sohn IS, Alcocer L et al. Projecting the long-term benefits of single pill combination therapy for patients with hypertension in five countries. Int J Cardiol Cardiovasc Risk Prev. 2021;10:200102. doi:10.1016/j.ijcrp.2021.200102Weisser B, Wilke T, Predel HG, Schmieder RE, Wassmann S, Gillessen A et al. Single pill treatment in daily practice is associated with improved clinical outcomes and all-cause mortality in cardiovascular diseases: results from the START project. Eur Heart J. 2022;43(Suppl. 2): ehac544.2254,. doi:10.1093/eurheartj/ehac544.2254Weisser B, Wilke T, Predel HG, Schmieder RE, Wassmann S, Gillessen A et al. Single pill treatment in daily practice is associated with improved clinical outcomes and all-cause mortality in cardiovascular diseases: results from the START project. Eur Heart J. 2022;43(Suppl. 2): ehac544.2254,. doi:10.1093/eurheartj/ehac544.2254Borghi C, Jayagopal PB, Konradi AO, Bortolotto LA, Degli Esposti L, Perrone V et al. Adherence to triple single-pill combination of perindopril/indapamide/amlodipine: findings from real-world analysis in Italy. Adv Ther. 2023;40(4):1765–1772. doi:10.1007/s12325-023-02451-yBorghi C, Jayagopal PB, Konradi AO, Bortolotto LA, Degli Esposti L, Perrone V et al. Adherence to triple single-pill combination of perindopril/indapamide/amlodipine: findings from real-world analysis in Italy. Adv Ther. 2023;40(4):1765–1772. doi:10.1007/s12325-023-02451-ySnyman JR, Bortolotto LA, Degli Esposti L, Jayagopal PB, Konradi AO, Perrone V et al. A real-world analysis of outcomes and healthcare costs of patients on perindopril/indapamide/amlodipine single-pill vs. multiple-pill combination in Italy. J Hypertens. 2024;42(1):136–142. doi:10.1097/HJH.0000000000003570Snyman JR, Bortolotto LA, Degli Esposti L, Jayagopal PB, Konradi AO, Perrone V et al. A real-world analysis of outcomes and healthcare costs of patients on perindopril/indapamide/amlodipine single-pill vs. multiple-pill combination in Italy. J Hypertens. 2024;42(1):136–142. doi:10.1097/HJH.0000000000003570McGrath D, Meador M, Wall HK, Padwal RS. Self-measured blood pressure telemonitoring programs: a pragmatic how-to guide. Am J Hypertens. 2023;36(8):417–427. doi:10.1093/ajh/hpad040McGrath D, Meador M, Wall HK, Padwal RS. Self-measured blood pressure telemonitoring programs: a pragmatic how-to guide. Am J Hypertens. 2023;36(8):417–427. doi:10.1093/ajh/hpad040Rea F, Morabito G, Savaré L, Pathak A, Corrao G, Mancia G. Adherence and related cardiovascular outcomes to single pill vs. separate pill administration of antihypertensive triple-combination therapy. J Hypertens. 2023;41(9):1466–1473. doi:10.1097/HJH.0000000000003497Rea F, Morabito G, Savaré L, Pathak A, Corrao G, Mancia G. Adherence and related cardiovascular outcomes to single pill vs. separate pill administration of antihypertensive triple-combination therapy. J Hypertens. 2023;41(9):1466–1473. doi:10.1097/HJH.0000000000003497Syed YY. Perindopril/indapamide/amlodipine in hypertension: a profile of its use. Am J Cardiovasc Drugs. 2022;22(2):219–230. doi:10.1007/s40256-022-00521-0Syed YY. Perindopril/indapamide/amlodipine in hypertension: a profile of its use. Am J Cardiovasc Drugs. 2022;22(2):219–230. doi:10.1007/s40256-022-00521-0

The authors declare that there are no conflicts of interest present.