• Hypertension

Hypertension is a leading cause of mortality worldwide, with an estimated 8.5 million deaths each year attributable to poor blood pressure (BP) control.1 Of an estimated 1.25 billion adults aged 30–79 years with hypertension, fewer than 1 in 5 have BP controlled to <140/90 mm Hg.2 These poor rates of control are attributable to barriers at each stage of the hypertension care process (figure 1). One major barrier is clinical inertia, that is, healthcare providers not escalating therapy when BP is uncontrolled. In one large study from the USA, a new antihypertensive medication class was added at only 12% of visits with an uncontrolled BP, consistent with other published estimates.3 Additionally, decades of clinical training and practice have used a ‘start low and go slow’ approach to managing hypertension: beginning treatment with a low dose of a single antihypertensive class and titrating the dose upward before adding another class. However, most patients will need more than one antihypertensive medication to achieve BP control, so the start low and go slow approach simply delays achievement of BP control. Another major barrier is that, even when patients are prescribed appropriate pharmacotherapy, BP control may be inadequate due to medication non-adherence. Nearly half of all antihypertensive medications are discontinued in the first year, and patients are more likely to miss doses of medications with more complex regimens.4 5

Fixed-dose combination medications, which combine low doses of antihypertensive medications from complementary medication classes in a single pill, may address some of these challenges. They partially offset clinical inertia—a single prescription results in …