TWICE-DAILY ADMINISTRATION OF SINGLE-PILL COMBINATIONS IN ANTIHYPERTENSIVE THERAPY IN EVERYDAY PRACTICE

Objective: Single-pill combination (SPC) therapy is the preferred formulation for hypertension treatment. However, there is limited data in the literature regarding twice-daily dosing of SPCs. Design and method: Data were collected in a brief retrospective self-assessment based on three months of data from a joint nephrology and hypertension outpatient clinic. Results: Out of 296 patients (131 male, 165 female), 83 (28%) were taking a dual or triple single-pill combination (SPC) for blood pressure (BP) reduction bid. Among them, 68 were perindopril-based (35 male and 33 female), while 15 were based on other agents, including enalapril, ramipril, telmisartan, irbesartan, valsartan, hydrochlorothiazide, and amlodipine. Among the perindopril-based combinations, 49 cases (23 male and 26 female) received a dual SPC twice daily, 13 cases (8 male and 5 female) received a dual SPC at one time of the day and a triple SPC at another time of the day, and 6 cases (4 male and 2 female) received a triple SPC twice daily. Among the twice-daily administered dual SPCs, in 12 cases (6 male and 6 female), one was perindopril/indapamide, and the other was perindopril/amlodipine. In 10 cases (7 male and 3 female) of the twice-daily administered dual SPC, both SPCs were perindopril/amlodipine. In 15 cases (5 male and 10 female), both SPCs were perindopril/indapamide. In the remaining 10 cases, the twice-daily administered dual SPC was ARB-based: 1 male took ARB/DIU and ARB/DHP-CA combinations, 3 females took ARB/DHP-CA combinations twice daily, and 2 males and 4 females took ARB/DIU combinations twice daily. Two patients who were not classified into any of these groups were taking different combination therapies twice daily. Conclusions: In the absence of evidence, randomized clinical trials, and professional recommendations, practical advice on the twice-daily dosing of SPC preparations can only be formulated by analogy with the twice-daily dosing of single-agent drugs.