title: Fixed-Dose Triple Combination of Antihypertensive Drugs Improves Blood Pressure Control: From Clinical Trials to Clinical Practice.
abstract: Blood pressure (BP) control is the main clinical goal in the management of hypertensive patients; however, BP in most of these patients remains uncontrolled, despite the widespread availability of antihypertensive drugs as free-combination therapy. This study compared the efficacy of a fixed-dose triple combination (FDTC) of antihypertensive drugs with that of a free combination of three antihypertensives in patients with uncontrolled hypertension.
  
  
  
  Ninety-two patients (mean age 60.8 ± 12.1, 58.0% male) with uncontrolled essential hypertension (office systolic BP ≥ 140 or diastolic BP ≥ 90 mmHg) previously treated with a renin-angiotensin-aldosterone system (RAAS) inhibitor plus hydrochlorothiazide were switched to once-daily FDTC therapy with perindopril/indapamide/amlodipine (5-10/1.25-2.5/5-10 mg). Patients were age- and sex-matched with a control group of hypertensive patients receiving free-combination therapy with three drugs including a RAAS inhibitor, a diuretic, and a calcium channel blocker. Office BP and 24-h ambulatory BP monitoring (ABPM) were evaluated at baseline and after 1 and 4 months.
  
  
  
  Significant reductions in ambulatory 24-h, daytime, and nighttime systolic BP, and pulse pressure (PP) were found in the FDTC group relative to reductions seen with free-combination therapy, after the first month only of follow-up. Target BP values (mean 24-h ambulatory systolic/diastolic BP < 130/80 mmHg) were reached by more recipients of FDTC than free-combination therapy (64.8% vs. 46.9%, p < 0.05) at month 4 of follow-up, despite reductions in 24-h ABPM values from baseline being similar in both groups at this time point.
  
  
  
  FDTC of perindopril/indapamide/amlodipine was effective at reducing SBP and PP in previously treated patients with uncontrolled hypertension, and well tolerated, providing support for clinicians in choosing a fixed-dose triple combination over the free-combination of a RAAS inhibitor, a diuretic, and a calcium antagonist.
authors.affiliation: Hypertension Centre Certified by the Italian Society of Hypertension, S. Maria della Misericordia Hospital, AULSS 5 Polesana, Rovigo, Italy. alberto.mazza@aulss5.veneto.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Mazza
authors.affiliation: Hypertension Centre and Internal Medicine and Geriatrics, San Donato Hospital, USL 8, Arezzo, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Lenti
authors.affiliation: Department of Medicine, S. Maria della Misericordia Hospital, AULSS 5 Polesana, Rovigo, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Schiavon
authors.affiliation: Department of Medicine, S. Maria della Misericordia Hospital, AULSS 5 Polesana, Rovigo, Italy.
authors.forename: Antonella Paola
authors.initials: AP
authors.lastname: Sacco
authors.affiliation: Interventional Cardiology Unit, Division of Cardiology, S. Maria della Misericordia Hospital, AULSS 5 Polesana, Rovigo, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Dell'Avvocata
authors.affiliation: Interventional Cardiology Unit, Division of Cardiology, S. Maria della Misericordia Hospital, AULSS 5 Polesana, Rovigo, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Rigatelli
authors.affiliation: Department of Medicine, S. Maria della Misericordia Hospital, AULSS 5 Polesana, Rovigo, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Ramazzina
mesh_terms: D000368:Aged; D017311:Amlodipine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D018660:Blood Pressure Monitoring, Ambulatory; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007190:Indapamide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D020913:Perindopril / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics; D004338:Drug Combinations; D017311:Amlodipine; D007190:Indapamide; D020913:Perindopril
keywords: Amlodipine; Antihypertensives; Hypertension; Indapamide; Perindopril; Target blood pressure; Triple fixed-dose combination