systhiperСистемные гипертензииSystemic Hypertension2075-082X2542-2189LLC «ИнтерМедсервис»10.38109/2075-082X-2024-1-5-13systhiper-804Research ArticleОБЗОРНАЯ СТАТЬЯREVIEWКонсенсус экспертов Российского медицинского общества по артериальной гипертонии: применение фиксированных комбинаций в лечении больных артериальной гипертониейRussian medical society expert consensus on arterial hypertension: use of fixed combinations in the treatment of patients with arterial hypertensionhttps://orcid.org/0000-0002-2028-8748КислякО. А.KisliakO. A.

Кисляк Оксана Андреевна, д.м.н., профессор

ул. Островитянова д. 1, г. Москва117997

Oksana A. Kisliak, Dr. of Sci. (Med.), Professor

Ostrovitianov str. 1, Moscow 117997

kisliakoa@mail.ruhttps://orcid.org/0000-0001-7895-9068ЖернаковаЮ. В.ZhernakovaJu. V.

Жернакова Юлия Валерьевна, д.м.н., ученый секретарь

ул. Академика Чазова, 15А, г. Москва 121552

Juliya V. Zhernakova, Dr. of Sci. (Med.)

St. Academician Chazova, 15 a, Moscow 121552

juli001@mail.ruhttps://orcid.org/0000-0001-8048-4882АксеноваА. В.AksenovaA. V.

Аксенова Анна Владимировна, к.м.н., старший научный сотрудник, отдел гипертонии

ул. Академика Чазова, 15А, г. Москва 121552

Anna V. Aksenova, Cand. of Sci. (Med.), Senior Researcher

St. Academician Chazova, 15 a, Moscow 121552

aksenovaannav@gmail.comhttps://orcid.org/0000-0002-9822-4357ЧазоваИ. Е.ChazovaI. E.

Чазова Ирина Евгеньевна, академик РАН, д.м.н., профессор, заместитель генерального директора по научно-экспертной работе, руководитель отдела гипертонии

ул. Академика Чазова, 15А, г. Москва 121552

Irina E. Chazova, Dr. of Sci. (Med.), Prof., Acad. of RAS, Deputy General Director for Scientific and Expert Work, Head of Hypertension Department

St. Academician Chazova, 15 a, Moscow 121552

c34h@yandex.ruФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава РоссииРоссияPirogov Russian National Research Medical UniversityRussian FederationИнститут клинической кардиологии им. А.Л. Мясникова, ФГБУ «Национальный медицинский исследовательский центр кардиологии имени академика Е.И. Чазова» Минздрава РоссииРоссияA.L. Myasnikov Scientific research institute of clinical cardiology, E.I. Chazov National Medical Research Center of cardiologyRussian Federation202429032024211513Copyright © Кисляк О.А., Жернакова Ю.В., Аксенова А.В., Чазова И.Е., 20242024Кисляк О.А., Жернакова Ю.В., Аксенова А.В., Чазова И.Е.Kisliak O.A., Zhernakova J.V., Aksenova A.V., Chazova I.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.syst-hypertension.ru/jour/article/view/804

Несмотря на большой арсенал антигипертензивных средств, контроль АД, как в Европе, так и в России по-прежнему остается на низком уровне, более 50% пациентов не достигают целевых уровней АД. Вместе с тем, данные результатов крупных РКИ демонстрируют, что достижение целевых значений АД возможно у большинства пациентов, резистентность к антигипертензивной терапии имеют не более 5-10% больных. Накоплено достаточно данных о том, что низкая приверженность к лечению остается фундаментальным фактором, способствующим недостаточному контролю АД. Получены доказательства того, что приверженность к лечению тесно коррелирует со сложным режимом дозирования препаратов и количеством принимаемых таблеток.

Доказано, что низкая приверженность связана с повышенным риском развития сердечно-сосудистых осложнений. Кроме того, фактические данные свидетельствуют о том, что медицинская инерция способствует неэффективности лечения у пациентов, остающихся на монотерапии или получающих неадекватную субоптимальную терапию. Использование комбинированной терапии, в том числе с применением фиксированных комбинаций у большинства пациентов может способствовать решению обеих этих проблем. Настоящий консенсус посвящен различным вопросам, связанным с назначением комбинированной терапии в виде фиксированных комбинаций и полипилл.

Despite the large arsenal of antihypertensive agents, BP control, both in Europe and in Russia, remains at a low level, more than 50% patients do not reach the goal BP levels. At the same time, data from the results of RCTs demonstrate that the achievement of goal BP values is possible in most patients, no more than 5-10% of patients have resistance to antihypertensive therapy. Sufficient evidence has been accumulated that low adherence to treatment remains a

fundamental contributing factor to insufficient BP control. There is evidence that adherence to treatment closely correlates with the complex dosing regimen of the drugs and the number of tablets taken. Low adherence has been shown to be associated with an increased risk of cardiovascular complications. Furthermore, evidence suggests that medical inertia contributes to treatment failure in patients remaining on monotherapy or receiving inadequate suboptimal therapy. The use of combination therapy, including the use of fixed combinations in most patients, can help to solve both problems. This consensus focuses on various issues related to the prescription of combination therapy in the form of fixed combinations and polypill.

артериальная гипертонияфиксированные комбинацииантигипертензивная терапияполипиллarterial hypertensionfixed combinationsantihypertensive therapypolypillReferencesWorldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population representative studies with 104 million participants. Lancet 2021; 398:957–980. https://doi.org/10.1016/s0140-6736(21)01330-1Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population representative studies with 104 million participants. Lancet 2021; 398:957–980. https://doi.org/10.1016/s0140-6736(21)01330-1Бойцов С.А., Баланова Ю.А., Шальнова С.А., и др. Артериальная гипертония среди лиц 25-64 лет: распространенность, осведомленность, лечение и контроль. По материалам исследования ЭССЕ. Кардиоваскулярная терапия и профилактика. 2014, 14(4):4–14. https://doi.org/10.15829/1728-8800-2014-4-4-14Boytsov S.A., Balanova Yu.A., Shalnova S.A., et al. Arterial hypertension among individuals of 25–64 years old: prevalence, awareness, treatment and control. by the data from ECCD. Cardiovascular Therapy and Prevention. 2014;13(4):4–14. (In Russ.). https://doi.org/10.15829/1728-8800-2014-4-4-14Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, Prospective Studies C. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360:1903–1913. https://doi.org/10.1016/s0140-6736(02)11911-8Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, Prospective Studies C. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360:1903–1913. https://doi.org/10.1016/s0140-6736(02)11911-8Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension. 1. Overview, meta-analyses, and metaregression analyses of randomized trials. J Hypertens 2014;32:2285–2295. https://doi.org/10.1097/hjh.0000000000000378Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure lowering on outcome incidence in hypertension. 1. Overview, meta-analyses, and metaregression analyses of randomized trials. J Hypertens 2014;32:2285–2295. https://doi.org/10.1097/hjh.0000000000000378Prabhakaran D, Anand S, Watkins D, Gaziano T, Wu Y, Mbanya JC, et al. Cardiovascular, respiratory, and related disorders: key messages from Disease Control Priorities. 3rd edition. Lancet 2018; 391:1224–1236. https://doi.org/10.1016/s0140-6736(17)32471-6Prabhakaran D, Anand S, Watkins D, Gaziano T, Wu Y, Mbanya JC, et al. Cardiovascular, respiratory, and related disorders: key messages from Disease Control Priorities. 3rd edition. Lancet 2018; 391:1224–1236. https://doi.org/10.1016/s0140-6736(17)32471-6Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet 2016; 387:957–967. https://doi.org/10.1016/s0140-6736(15)01225-8Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, et al. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet 2016; 387:957–967. https://doi.org/10.1016/s0140-6736(15)01225-8Xie X, Atkins E, Lv J, Bennett A, Neal B, Ninomiya T, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Lancet 2016; 387:435–443. https://doi.org/10.1016/s0140-6736(15)00805-3Xie X, Atkins E, Lv J, Bennett A, Neal B, Ninomiya T, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis. Lancet 2016; 387:435–443. https://doi.org/10.1016/s0140-6736(15)00805-3Tsai WC, Wu HY, Peng YS, Yang JY, Chen HY, Chiu YL, et al. Association of Intensive Blood Pressure Control and Kidney Disease Progression in Nondiabetic Patients With Chronic Kidney Disease: A Systematic Review and Meta-analysis. JAMA Intern Med 2017; 177:792–799. https://doi.org/10.1001/jamainternmed.2017.0197Tsai WC, Wu HY, Peng YS, Yang JY, Chen HY, Chiu YL, et al. Association of Intensive Blood Pressure Control and Kidney Disease Progression in Nondiabetic Patients With Chronic Kidney Disease: A Systematic Review and Meta-analysis. JAMA Intern Med 2017; 177:792–799. https://doi.org/10.1001/jamainternmed.2017.0197Agabiti Rosei E, Muiesan, M.L. Evaluation of Cardiac Damage in Hypertension: Echocardiography. In: Mancia EA-RaG, editor. Asessment of Prclinical Organ Damage in Hypertension: Springer; 2015. pp. 13- 25. https://doi.org/10.1007/978-3-319-15603-3_2Agabiti Rosei E, Muiesan, M.L. Evaluation of Cardiac Damage in Hypertension: Echocardiography. In: Mancia EA-RaG, editor. Asessment of Prclinical Organ Damage in Hypertension: Springer; 2015. pp. 13- 25. https://doi.org/10.1007/978-3-319-15603-3_2White WB, Wakefield DB, Moscufo N, Guttmann CRG, Kaplan RF, Bohannon RW, et al. Effects of Intensive Versus Standard Ambulatory Blood Pressure Control on Cerebrovascular Outcomes in Older People (INFINITY). Circulation 2019; 140:1626–1635. https://doi.org/10.1161/circulationaha.119.041603White WB, Wakefield DB, Moscufo N, Guttmann CRG, Kaplan RF, Bohannon RW, et al. Effects of Intensive Versus Standard Ambulatory Blood Pressure Control on Cerebrovascular Outcomes in Older People (INFINITY). Circulation 2019; 140:1626–1635. https://doi.org/10.1161/circulationaha.119.041603Williamson JD, Pajewski NM, Auchus AP, Bryan RN, Chelune G, Cheung AK, et al. Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia: A Randomized Clinical Trial. JAMA 2019; 321:553–561. https://doi.org/10.1001/jama.2018.21442Williamson JD, Pajewski NM, Auchus AP, Bryan RN, Chelune G, Cheung AK, et al. Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia: A Randomized Clinical Trial. JAMA 2019; 321:553–561. https://doi.org/10.1001/jama.2018.21442Brunstrom M, Carlberg B. Association of Blood Pressure Lowering With Mortality and Cardiovascular Disease Across Blood Pressure Levels: A Systematic Review and Meta-analysis. JAMA Intern Med 2018; 178:28–36. https://doi.org/10.1001/jamainternmed.2017.6015Brunstrom M, Carlberg B. Association of Blood Pressure Lowering With Mortality and Cardiovascular Disease Across Blood Pressure Levels: A Systematic Review and Meta-analysis. JAMA Intern Med 2018; 178:28–36. https://doi.org/10.1001/jamainternmed.2017.6015Wald DS, Law M, Morris JK, Bestwick JP, Wald NJ. Combination therapy versus monotherapy in reducing blood pressure: meta-analysis on 11,000 participants from 42 trials. Am J Med. 2009 Mar;122(3):290-300. https://doi.org/10.1016/j.amjmed.2008.09.038Wald DS, Law M, Morris JK, Bestwick JP, Wald NJ. Combination therapy versus monotherapy in reducing blood pressure: meta-analysis on 11,000 participants from 42 trials. Am J Med. 2009 Mar;122(3):290-300. https://doi.org/10.1016/j.amjmed.2008.09.038Savare L, Rea F, Corrao G, Mancia G. Use of initial and subsequent antihypertensive combination treatment in the last decade: analysis of a large Italian database. J Hypertens 2022; 40:1768–1775. https://doi.org/10.1097/hjh.0000000000003215Savare L, Rea F, Corrao G, Mancia G. Use of initial and subsequent antihypertensive combination treatment in the last decade: analysis of a large Italian database. J Hypertens 2022; 40:1768–1775. https://doi.org/10.1097/hjh.0000000000003215Mancia G, Rea F, Corrao G, Grassi G. Two-drug combinations as first-step antihypertensive treatment. Circ Res 2019; 124:1113–1123. https://doi.org/10.1161/circresaha.118.313294Mancia G, Rea F, Corrao G, Grassi G. Two-drug combinations as first-step antihypertensive treatment. Circ Res 2019; 124:1113–1123. https://doi.org/10.1161/circresaha.118.313294Rea F, Corrao G, Merlino L, Mancia G. Initial antihypertensive treatment strategies and therapeutic inertia. Hypertension (Dallas, Tex: 1979) 2018; 72:846–853. https://doi.org/10.1161/hypertensionaha.118.11308Rea F, Corrao G, Merlino L, Mancia G. Initial antihypertensive treatment strategies and therapeutic inertia. Hypertension (Dallas, Tex: 1979) 2018; 72:846–853. https://doi.org/10.1161/hypertensionaha.118.113082018 ESC/ESH Guidelines for the management of arterial hypertension. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I; ESC Scientific Document Group. Eur Heart J. 2018 Sep 1;39(33):3021-3104. https://doi.org/10.1093/eurheartj/ehy3392018 ESC/ESH Guidelines for the management of arterial hypertension. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope L, Zanchetti A, Kerins M, Kjeldsen SE, Kreutz R, Laurent S, Lip GYH, McManus R, Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V, Desormais I; ESC Scientific Document Group. Eur Heart J. 2018 Sep 1;39(33):3021-3104. https://doi.org/10.1093/eurheartj/ehy339Чазова И.Е., Жернакова Ю.В. от имени экспертов. Клинические рекомендации. Диагностика и лечение артериальной гипертонии. Системные гипертензии 2019;16(1):6-31. https://doi.org/10.26442/2075082X.2019.1.190179Chazova I.E., Zhernakova Yu.V. Diagnosis and treatment of arterial hypertension [Guidelines]. Systemic Hypertension. 2019;16(1):6-31. (In Russ.) https://doi.org/10.26442/2075082X.2019.1.190179Hilleman DE, Ryschon KL, Mohiuddin SM, Wurdeman RL. Fixed-dose combination vs monotherapy in hypertension: a meta-analysis evaluation. J Hum Hypertens. 1999;13:477–483. https://doi.org/10.1038/sj.jhh.1000855Hilleman DE, Ryschon KL, Mohiuddin SM, Wurdeman RL. Fixed-dose combination vs monotherapy in hypertension: a meta-analysis evaluation. J Hum Hypertens. 1999;13:477–483. https://doi.org/10.1038/sj.jhh.1000855Kang S, Wu YF, An N, Ren M. A systematic review and meta-analysis of the efficacy and safety of a fixed, low-dose perindopril-indapamide combination as first-line treatment of hypertension. Clin Ther 2004;26:257–270. https://doi.org/10.1016/s0149-2918(04)90024-0Kang S, Wu YF, An N, Ren M. A systematic review and meta-analysis of the efficacy and safety of a fixed, low-dose perindopril-indapamide combination as first-line treatment of hypertension. Clin Ther 2004;26:257–270. https://doi.org/10.1016/s0149-2918(04)90024-0Epstein M, Bakris G. Newer approaches to antihypertensive therapy. Use of fixed-dose combination therapy. Arch Intern Med. 1996;156:1969–78. https://doi.org/10.1001/archinte.1996.00440160081011Epstein M, Bakris G. Newer approaches to antihypertensive therapy. Use of fixed-dose combination therapy. Arch Intern Med. 1996;156:1969–78. https://doi.org/10.1001/archinte.1996.00440160081011Gerbino PP, Shoheiber O. Adherence patterns among patients treated with fixed-dose combination versus separate antihypertensive agents. Am J Health Syst Pharm. 2007;64:1279–1283. https://doi.org/10.2146/ajhp060434Gerbino PP, Shoheiber O. Adherence patterns among patients treated with fixed-dose combination versus separate antihypertensive agents. Am J Health Syst Pharm. 2007;64:1279–1283. https://doi.org/10.2146/ajhp060434Schroeder K, Fahey T, Ebrahim S. How can we improve adherence to blood pressure-lowering medication in ambulatory care? Systematic review of randomized controlled trials. Arch Intern Med. 2004;164:722–732. https://doi.org/10.1001/archinte.164.7.722Schroeder K, Fahey T, Ebrahim S. How can we improve adherence to blood pressure-lowering medication in ambulatory care? Systematic review of randomized controlled trials. Arch Intern Med. 2004;164:722–732. https://doi.org/10.1001/archinte.164.7.722Gupta AK, Arshad S, Poulter NR. Compliance, safety, and effectiveness of fxed-dose combinations of antihypertensive agents: a meta-analysis. Hypertension 2010;55:399-407. https://doi.org/10.1161/hypertensionaha.109.139816Gupta AK, Arshad S, Poulter NR. Compliance, safety, and effectiveness of fxed-dose combinations of antihypertensive agents: a meta-analysis. Hypertension 2010;55:399-407. https://doi.org/10.1161/hypertensionaha.109.139816Verma AA, Khuu W, Tadrous M, Gomes T, Mamdani MM (2018) Fixed-dose combination antihypertensive medications, adherence, and clinical outcomes: A population-based retrospective cohort study. PLoS Med 15(6): e1002584. https://doi.org/10.1371/journal.pmed.1002584Verma AA, Khuu W, Tadrous M, Gomes T, Mamdani MM (2018) Fixed-dose combination antihypertensive medications, adherence, and clinical outcomes: A population-based retrospective cohort study. PLoS Med 15(6): e1002584. https://doi.org/10.1371/journal.pmed.1002584Чазова И.Е., Ратова Л.Г. Комбинированная терапия артериальной гипертонии. В кн.: Руководство по артериальной гипертонии. Под редакцией академика Е.И. Чазова, профессора И.Е. Чазовой. М.: Медиа Медика, 2005, с.655-677.Chazova I.E., Ratova L.G. Combination therapy of arterial hypertension. In the book: Guide to arterial hypertension. Edited by Acad. E.I. Chazov, prof. I.E. Chazova. M.: Media Medica, 2005, pp. 655-677. (in Russ.)Кобалава Ж.Д., Конради А.О., Недогода С.В., Шляхто Е.В. и соавт. Артериальная гипертензия у взрослых. Клинические рекомендации 2020. Российский кардиологический журнал. 2020;25(3):3786. https://doi.org/10.15829/1560-4071-2020-3-3786Kobalava Zh.D., Konradi A.O., Nedogoda S.V., Shlyakhto E.V., et al. Arterial hypertension in adults. Clinical guidelines 2020. Russian Journal of Cardiology. 2020;25(3):3786. (In Russ.). https://doi.org/10.15829/1560-4071-2020-3-3786Coca A, Agabiti-Rosei E, Cifkova R, Manolis AJ, Redon J, Mancia G. The polypill in cardiovascular prevention: evidence, limitations and perspective – position paper of the European Society of Hypertension. J Hypertens 2017;35:1546–1553. https://doi.org/10.1097/hjh.0000000000001390Coca A, Agabiti-Rosei E, Cifkova R, Manolis AJ, Redon J, Mancia G. The polypill in cardiovascular prevention: evidence, limitations and perspective – position paper of the European Society of Hypertension. J Hypertens 2017;35:1546–1553. https://doi.org/10.1097/hjh.0000000000001390Castellano JM, Sanz G, Peñalvo JL, et al. A polypill strategy to improve adherence: results from the FOCUS project. J Am Coll Cardiol. 2014;64(20):2071-2082. https://doi.org/10.1016/j.jacc.2014.08.021.Castellano JM, Sanz G, Peñalvo JL, et al. A polypill strategy to improve adherence: results from the FOCUS project. J Am Coll Cardiol. 2014;64(20):2071-2082. https://doi.org/10.1016/j.jacc.2014.08.021.Patel P, Ordunez P, DiPette D, et al. Improved blood pressure control to reduce cardiovascular disease morbidity and mortality: the standardized hypertension treatment and prevention project. J Clin Hypertens. 2016;18(12):1284‐1294. https://doi.org/10.1111/jch.12861Patel P, Ordunez P, DiPette D, et al. Improved blood pressure control to reduce cardiovascular disease morbidity and mortality: the standardized hypertension treatment and prevention project. J Clin Hypertens. 2016;18(12):1284‐1294. https://doi.org/10.1111/jch.12861Sarzani R, Laureti G, Gezzi A, Spannella F, Giulietti F. Single-pill fixed-dose drug combinations to reduce blood pressure: the right pill for the right patient. Therapeutic Advances in Chronic Disease. 2022;13. https://doi.org/10.1177/20406223221102754Sarzani R, Laureti G, Gezzi A, Spannella F, Giulietti F. Single-pill fixed-dose drug combinations to reduce blood pressure: the right pill for the right patient. Therapeutic Advances in Chronic Disease. 2022;13. https://doi.org/10.1177/20406223221102754Mancia G, Kreutz R, Brunstrom M et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens. 2023 Jun 21. https://doi.org/10.1097/hjh.0000000000003480Mancia G, Kreutz R, Brunstrom M et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension Endorsed by the European Renal Association (ERA) and the International Society of Hypertension (ISH). J Hypertens. 2023 Jun 21. https://doi.org/10.1097/hjh.0000000000003480Jaffe MG, Lee GA, Young JD, Sidney S, Go AS. Improved blood pressure control associated with a large‐ scale hypertension program.JAMA. 2013;310(7):699-705. https://doi.org/10.1001/jama.2013.108769Jaffe MG, Lee GA, Young JD, Sidney S, Go AS. Improved blood pressure control associated with a large‐ scale hypertension program.JAMA. 2013;310(7):699-705. https://doi.org/10.1001/jama.2013.108769Dahlöf B, Sever PS, Poulter NR, et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet (London, England) 2005; 366: 895–906. https://doi.org/10.1016/s0140-6736(05)67185-1Dahlöf B, Sever PS, Poulter NR, et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet (London, England) 2005; 366: 895–906. https://doi.org/10.1016/s0140-6736(05)67185-1Essa M., Ross JS, Dhruba S et al. Abstract 13591: Utilization and Spending on Fixed-Dose Combination Treatment for Hypertension in Medicare and Medicaid, 2016-2020. Circulation. 6 Nov 2023;148:A13591. https://doi.org/10.1161/circ.148.suppl_1.13591Essa M., Ross JS, Dhruba S et al. Abstract 13591: Utilization and Spending on Fixed-Dose Combination Treatment for Hypertension in Medicare and Medicaid, 2016-2020. Circulation. 6 Nov 2023;148:A13591. https://doi.org/10.1161/circ.148.suppl_1.13591Mahfoud F, Kieble M., Enners S et al. Use of fxed dose combination antihypertensives in Germany between 2016 and 2020: an example of guideline inertia. Clinical Research in Cardiology (2023) 112:197– 202. https://doi.org/10.1007/s00392-022-01993-5Mahfoud F, Kieble M., Enners S et al. Use of fxed dose combination antihypertensives in Germany between 2016 and 2020: an example of guideline inertia. Clinical Research in Cardiology (2023) 112:197– 202. https://doi.org/10.1007/s00392-022-01993-5Cicero AFG, Landolfo M, Borghi C. Are monotherapies still valuable to the treatment of hypertension? Expert Opin Pharmacother. 2020;21(13):1523-1526. https://doi.org/10.1080/14656566.2020.1770728Cicero AFG, Landolfo M, Borghi C. Are monotherapies still valuable to the treatment of hypertension? Expert Opin Pharmacother. 2020;21(13):1523-1526. https://doi.org/10.1080/14656566.2020.1770728Cho HW, Kang SH, Kim CH. Medication persistence and adherence: A key approach to improve hypertension management. Eur J Prev Cardiol. 2021;28(14):e17-e19. https://doi.org/10.1177/2047487320905191Cho HW, Kang SH, Kim CH. Medication persistence and adherence: A key approach to improve hypertension management. Eur J Prev Cardiol. 2021;28(14):e17-e19. https://doi.org/10.1177/2047487320905191Shani M, Lustman A, Comaneshter D, Schonmann Y. Associations of Chronic Medication Adherence with Emergency Room Visits and Hospitalizations. J Gen Intern Med. 2022;37(5):1060-1064. https://doi.org/10.1007/s11606-021-06864-9Shani M, Lustman A, Comaneshter D, Schonmann Y. Associations of Chronic Medication Adherence with Emergency Room Visits and Hospitalizations. J Gen Intern Med. 2022;37(5):1060-1064. https://doi.org/10.1007/s11606-021-06864-9Chow CK, Thakkar J, Bennett A, et al. Quarter-dose quadruple combination therapy for initial treatment of hypertension: placebo-controlled, crossover, randomised trial and systematic review. Lancet. 2017;389(10073):1035-1042. https://doi.org/10.1016/S0140-6736(17)30260-XChow CK, Thakkar J, Bennett A, et al. Quarter-dose quadruple combination therapy for initial treatment of hypertension: placebo-controlled, crossover, randomised trial and systematic review. Lancet. 2017;389(10073):1035-1042. https://doi.org/10.1016/S0140-6736(17)30260-XChow CK, Atkins ER, Hillis GS, et al. Initial treatment with a single pill containing quadruple combination of quarter doses of blood pressure medicines versus standard dose monotherapy in patients with hypertension (QUARTET): a phase 3, randomised, double-blind, active-controlled trial. Lancet. 2021;398(10305):1043-1052. https://doi.org/10.1016/S0140-6736(21)01922-XChow CK, Atkins ER, Hillis GS, et al. Initial treatment with a single pill containing quadruple combination of quarter doses of blood pressure medicines versus standard dose monotherapy in patients with hypertension (QUARTET): a phase 3, randomised, double-blind, active-controlled trial. Lancet. 2021;398(10305):1043-1052. https://doi.org/10.1016/S0140-6736(21)01922-XГринштейн Ю.И., Шабалин В.В., Руф Р.Р., Шальнова С.А., Драпкина О.М. Распространенность сочетания артериальной гипертонии и дислипидемии среди взрослого населения крупного Восточносибирского региона. Кардиоваскулярная терапия и профилактика. 2021;20(4):2865. https://doi.org/10.15829/1728-8800-2021-2865Grinshtein Yu.I., Shabalin V.V., Ruf R.R., Shalnova S.A., Drapkina O.M. Prevalence of a combination of hypertension and dyslipidemia among the adult population of a large East Siberian region. Cardiovascular Therapy and Prevention. 2021;20(4):2865. https://doi.org/10.15829/1728-8800-2021-2865Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486-2497. https://doi.org/10.1001/jama.285.19.2486Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486-2497. https://doi.org/10.1001/jama.285.19.2486Mancia G. Total cardiovascular risk: a new treatment concept. J Hypertens Suppl. 2006;24(2):S17-S24. https://doi.org/10.1097/01.hjh.0000220099.12154.c1Mancia G. Total cardiovascular risk: a new treatment concept. J Hypertens Suppl. 2006;24(2):S17-S24. https://doi.org/10.1097/01.hjh.0000220099.12154.c1Аксенова А.В., Ощепкова Е.В., Чазова И.Е. Лечение больных артериальной гипертонией в реальной клинической практике в 2010–2020 гг. (по данным национального регистра артериальной гипертонии). Терапевтический архив. 2022;94(1):9–17. https://doi.org/10.26442/00403660.2022.01.201318Aksenova AV, Oschepkova EV, Chazova IE. Treatment of patients with arterial hypertension in clinical practice in 2010–2020 (according to the national register of hypertension). Terapevticheskii Arkhiv (Ter. Arkh.). 2022;94(1):9–17. (in Russ.) https://doi.org/10.26442/00403660.2022.01.201318Shantsila E, Kozieł-Siołkowska M, Lip GY. Antiplatelet agents and anticoagulants for hypertension. Cochrane Database Syst Rev. 2022;7:CD003186. Published 2022 Jul 28. https://doi.org/10.1002/14651858.CD003186.pub4Shantsila E, Kozieł-Siołkowska M, Lip GY. Antiplatelet agents and anticoagulants for hypertension. Cochrane Database Syst Rev. 2022;7:CD003186. Published 2022 Jul 28. https://doi.org/10.1002/14651858.CD003186.pub4Wakai E, Ikemura K, Kato C, Okuda M. Effect of number of medications and complexity of regimens on medication adherence and blood pressure management in hospitalized patients with hypertension. PLoS One. 2021;16(6):e0252944. Published 2021 Jun 10. https://doi.org/10.1371/journal.pone.0252944Wakai E, Ikemura K, Kato C, Okuda M. Effect of number of medications and complexity of regimens on medication adherence and blood pressure management in hospitalized patients with hypertension. PLoS One. 2021;16(6):e0252944. Published 2021 Jun 10. https://doi.org/10.1371/journal.pone.0252944Lawson AJ, Hameed MA, Brown R, Cappuccio FP, George S, Hinton T, Kapil V, Lenart J, Lobo MD, Martin U, Menon M, Nightingale A, Rylance PB, Webb DJ, Dasgupta I. Nonadherence to antihypertensive medications is related to pill burden in apparent treatment-resistant hypertensive individuals. J Hypertens. 2020 Jun;38(6):1165-1173. PMID: 32371807. https://doi.org/10.1097/HJH.0000000000002398Lawson AJ, Hameed MA, Brown R, Cappuccio FP, George S, Hinton T, Kapil V, Lenart J, Lobo MD, Martin U, Menon M, Nightingale A, Rylance PB, Webb DJ, Dasgupta I. Nonadherence to antihypertensive medications is related to pill burden in apparent treatment-resistant hypertensive individuals. J Hypertens. 2020 Jun;38(6):1165-1173. PMID: 32371807. https://doi.org/10.1097/HJH.0000000000002398Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80% [published correction appears in BMJ. 2003 Sep 13;327(7415):586] [published correction appears in BMJ. 2006 Sep;60(9):823]. BMJ. 2003;326(7404):1419. https://doi.org/10.1136/bmj.326.7404.1419Wald NJ, Law MR. A strategy to reduce cardiovascular disease by more than 80% [published correction appears in BMJ. 2003 Sep 13;327(7415):586] [published correction appears in BMJ. 2006 Sep;60(9):823]. BMJ. 2003;326(7404):1419. https://doi.org/10.1136/bmj.326.7404.1419Khan AA, Siddiqui SA, Yasmin F, et al. The Era of Polypills in the Management of Cardiovascular Diseases: Are We There Yet? Curr Probl Cardiol. 2023;48(8):101233. https://doi.org/10.1016/j.cpcardiol.2022.101233Khan AA, Siddiqui SA, Yasmin F, et al. The Era of Polypills in the Management of Cardiovascular Diseases: Are We There Yet? Curr Probl Cardiol. 2023;48(8):101233. https://doi.org/10.1016/j.cpcardiol.2022.101233Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-177. https://doi.org/10.1093/eurheartj/ehx393Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-177. https://doi.org/10.1093/eurheartj/ehx393Joseph P, Roshandel G, Gao P, et al. Fixed-dose combination therapies with and without aspirin for primary prevention of cardiovascular disease: an individual participant data meta-analysis. Lancet. 2021;398(10306):1133-1146. https://doi.org/10.1016/S0140-6736(21)01827-4Joseph P, Roshandel G, Gao P, et al. Fixed-dose combination therapies with and without aspirin for primary prevention of cardiovascular disease: an individual participant data meta-analysis. Lancet. 2021;398(10306):1133-1146. https://doi.org/10.1016/S0140-6736(21)01827-4Coca A, Kreutz R, Manolis AJ, Mancia G. A practical approach to switch from a multiple pill therapeutic strategy to a polypill-based strategy for cardiovascular prevention in patients with hypertension. J Hypertens. 2020;38(10):1890-1898. https://doi.org/10.1097/HJH.0000000000002464Coca A, Kreutz R, Manolis AJ, Mancia G. A practical approach to switch from a multiple pill therapeutic strategy to a polypill-based strategy for cardiovascular prevention in patients with hypertension. J Hypertens. 2020;38(10):1890-1898. https://doi.org/10.1097/HJH.0000000000002464Rao S, Jamal Siddiqi T, Khan MS, et al. Association of polypill therapy with cardiovascular outcomes, mortality, and adherence: A systematic review and meta-analysis of randomized controlled trials. Prog Cardiovasc Dis. 2022;73:48-55. https://doi.org/10.1016/j.pcad.2022.01.005Rao S, Jamal Siddiqi T, Khan MS, et al. Association of polypill therapy with cardiovascular outcomes, mortality, and adherence: A systematic review and meta-analysis of randomized controlled trials. Prog Cardiovasc Dis. 2022;73:48-55. https://doi.org/10.1016/j.pcad.2022.01.005Poulter NR, Borghi C, Parati G, et al. Medication adherence in hypertension. J Hypertens. 2020;38(4):579- 587. https://doi.org/10.1097/HJH.0000000000002294Poulter NR, Borghi C, Parati G, et al. Medication adherence in hypertension. J Hypertens. 2020;38(4):579- 587. https://doi.org/10.1097/HJH.0000000000002294

The authors declare that there are no conflicts of interest present.