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This document discusses the use of triple single pill combination therapy in the management of hypertension. It notes that dual drug combinations are often insufficient to achieve blood pressure control goals, and that triple drug combinations provide greater synergism and efficacy. The rationale for triple combination therapy includes targeting multiple mechanisms, synergistic actions, metabolic modulation, and improved compliance through reduced pill burden. The document concludes that while triple drug combinations can effectively reduce blood pressure safely, some criticism relates to the inability to have customized therapies and potential for long-term issues like hypotension.
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Presentation09.pptx
- 1. TRIPLE SINGLE PILL COMBINATION IN THE MANAGEMENT OF HYPERTENSION DR M S ADITYA
- 2. HYPERTENSION
- 3. HYPERTENSION-CURRENT PERSPECTIVE – A CASE FOR RENEWED APPROACH Changing goal posts in management of hypertension Emphasis on TOD and cardiovascular protection Improved understanding of pathobiology of hypertension Seen more as an effect than cause of vascular disease Socio economic burden vast and increasingly recognized More pronounced and profound impact in coming years Early and impactful interventions likely to bring vast benefits to society and limit damage Subject needs to be dealt with at clinic level/ community level
- 6. COMPONENTS OF HYPERTENSION MANAGEMENT- TRENDS Achieving targeted reduction for new cutoffs Central blood pressure reduction as a desired goal Minimizing BP variation Minimizing time to achieve reduction Enhancing cardiovascular protection Minimizing adverse events Managing CO-MORBID conditions Individualizing treatment
- 7. HYPERTENSION-PATHOGENESIS Multifactorial, multisystem entity Regulatory and counterregulatory systems at play Many therapeutic targets possible Potential for largescale interactions and adversity Interplay of factors extending across time and severity Possible long term and intermediate impact on outcomes Increasing addition to this list from parallel pathologies (Hyperglycemia, Dyslipidemia )
- 10. MULTIDRUG THERAPY Combinations inherently more successful in achieving BP control Monotherapy escalation associated with increased adverse events and narrowing therapeutic benefits Earlier combinations potent and effective but cardiovascular benefit sketchy Later combinations more focused on efficacy and providing cardiovascular protection 2 drug combinations standard of practice in several settings However limitations remain in achieving BP controls
- 11. APPROACH SO FAR
- 12. LIMITATIONS TO ACHIEVING BP CONTROL Lack of efficacy-Several studies showed need for 3 drugs to achieve BP control Incapable of reaching past treatment goals with 2 drugs , impossible to achieve present goals Therapeutic inertia Lack of adherence Prolonged time to achieve control if at all Largely confined to clinics, not addressed at community level
- 14. Solutions to the problem-Three drug combinations Three drug combinations will achieve greater synergism Achieve quick BP control Treat High grades of hypertension with combinations directly to achieve fast and effective BP reduction Might prove to be useful as initial therapy in patients with moderate hypertension(lower dose combinations) to improve compliance Improve compliance while minimizing adverse events Greater cost savings Decreasing pill burden Useful in public health sphere/Decrease burden on HCP strategizing treatment
- 16. Rationale for combination Efficacy superior to monotherapy/ dual combinations Synergistic actions amplified Potential to cancel out metabolic/side effects Metabolic/vascular modulation (insulin sensitivity, potassium ,edema pleiotropy, remodelling, etc) Compliance Improved pharmacodynamics May provide legacy benefits
- 20. VALUE OF TIME IN BP CONTROL
- 21. WHY THIS TRIAL IS IMPORTANT? Done in public health sphere Similar to Indian population Cost savings demonstrated Difference in performance in real world might be wider Adverse events not demonstrably high Overcomes therapeutic inertia Simple message to health care providers
- 22. BENEFITS OF TREATING TO TARGET MODERATE HYPERTENSIVES AS WELL
- 25. WHAT COMBINATIONS? ACEI/CCB/DIURETIC(PERINDOPRIL/AMLODIPINE/INDAPAMIDE)- Maximum cardiovascular benefit predicted ARB/CCB/DIURETIC(TELMISARTAN/OLMESARTAN/AMLODIPINE/CILINDIPIN E/HCTZ/CTD)- Less side effects expected DRI/CCB/DIURETIC- not much experience in Indian setting Long acting drugs with neutral metabolic profile likely to provide maximum benefit Though some drugs are popular evidence is sketchy ( HCTZ )
- 27. CONCLUSIONS Triple drug combinations provide an effective means to achieve BP reduction safely Achieve the same fast and reliably Likely to improve compliance No net increase in adverse profile Early institution of therapy helpful in high grade hypertension Community dimension unique and worth pursuing Criticism involves inability to have tailormade therapies Potential for hypotension/adversity in long term
- 28. THANK YOU