title: A single fixed-dose combination for all patients is bad medicine.
abstract: It has been proposed that cardiovascular risk could be markedly reduced by prescribing a single daily pill to all patients at risk. This concept is bad medicine, because each constituent has problems, and the problems are different for each patient. A key principle of clinical pharmacology is individualization of therapy. Patients are not all the same, so a single polypill cannot work for all of them. For patients with resistant hypertension, at least 3 different versions would be needed for patients with different causes of hypertension, and even then not one pill would be suitable for all patients.
authors.affiliation: Division of Clinical Pharmacology, Department of Medicine, Western University, London, Ontario, Canada; Robarts Research Institute, London, Ontario, Canada; Division of Neurology, Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada. Electronic address: dspence@robarts.ca.
authors.forename: J David
authors.initials: JD
authors.lastname: Spence
mesh_terms: D000959:Antihypertensive Agents / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D014943:Global Health; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology; D055118:Medication Adherence; D009017:Morbidity / Q000639:trends; D010818:Practice Patterns, Physicians'; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents