title: The efficacy and tolerability of 'polypills': meta-analysis of randomised controlled trials.
abstract: BACKGROUND
  To assess the blood pressure and lipid-lowering efficacy and tolerability of 'polypills' used in cardiovascular disease prevention trials.
  
  
  RESULTS
  Systematic review and meta-analysis.
  
  
  METHODS
  The Cochrane Central Register of Controlled Trials, Medline, and PubMed databases were searched for eligible trials. Study inclusion criteria: Randomised controlled trials of at least six weeks duration, which compared a 'polypill' (that included at least one anti-hypertensive and one lipid-lowering medication) with a placebo (or one active component).
  
  
  METHODS
  Change from baseline in systolic and diastolic blood pressures, and total and LDL-cholesterol; discontinuation of study medication and reported adverse effects. Of 44 potentially eligible studies, six trials (including 2,218 patients without previous cardiovascular disease) fulfilled the inclusion criteria. Compared with placebo, 'polypills' reduced systolic blood pressure by -9.2 mmHg (95% confidence interval (CI): -13.4, -5.0) diastolic blood pressure by -5.0 mmHg (95%CI: -7.4, -2.6), total cholesterol by -1.22 mmol/L (95%CI: -1.60, -0.84) and LDL-cholesterol by -1.02 mmol/L (95%CI: -1.37, -0.67). However, those taking a 'polypill' (vs. placebo or component) were more likely to discontinue medication (20% vs 14%) (Odds ratio: 1.5 (95% CI: 1.2, 1.9)). There was no significant difference in reported adverse effects amongst those on a 'polypill' (36% vs. 28%) (OR: 1.3 (95%CI: 0.7, 2.5)). There was high statistical heterogeneity in comparisons for blood pressure and lipid-lowering but use of random-effects and quality-effects models produced very similar results.
  
  
  CONCLUSIONS
  Compared with placebo, the 'polypills' reduced blood pressure and lipids. Tolerability was lower amongst those on 'polypills' than those on placebo or one component, but differences were moderate. Effectiveness trials are needed to help clarify the status of 'polypills' in primary care and prevention strategies.
authors.affiliation: School of Population Health, University of Auckland, Auckland, New Zealand. c.elley@auckland.ac.nz
authors.forename: C Raina
authors.initials: CR
authors.lastname: Elley
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Gupta
authors.forename: Ruth
authors.initials: R
authors.lastname: Webster
authors.forename: Vanessa
authors.initials: V
authors.lastname: Selak
authors.forename: Min
authors.initials: M
authors.lastname: Jun
authors.forename: Anushka
authors.initials: A
authors.lastname: Patel
authors.forename: Anthony
authors.initials: A
authors.lastname: Rodgers
authors.forename: Simon
authors.initials: S
authors.lastname: Thom
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases; D004338:Drug Combinations; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000959:Antihypertensive Agents; D004338:Drug Combinations; D000960:Hypolipidemic Agents