Polypill for BP and cholesterol control beats usual care in some populations

  • Muñoz D & al.
  • N Engl J Med
  • 19 sept. 2019

  • de Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • A combination pill for warding off systolic BP elevation and high low-density lipoprotein cholesterol (LDL-C) beats usual care among socioeconomically vulnerable minorities.
  • The intervention proved feasible and effective in this real-world, randomized trial.

Why this matters

  • People in vulnerable populations struggle against the dual insult of higher rates of cardiovascular disease and obstacles to preventive care.
  • Low-dose polypills show promise for both primary prevention and easier accessibility.

Key results

  • 96% of trial participants were black, and ~75% had an income
  • At baseline, BP was 140/83 mm Hg; LDL-C was 113 mg/dL.
  • The polypill cost $26/month.
  • Median adherence at 1 year was 86% (interquartile range, 79%-93%).
  • Systolic BP dropped by an average 9 mm Hg with polypill vs 2 mm Hg with usual care (P=.003).
  • LDL-C mean dropped by 15 mg/dL with the polypill and 4 mg/dL with usual care (P<.001>
  • 2% with polypill had therapy escalation vs 10% with usual care.
  • 2 cardiac-related serious adverse events (1 stroke death, 1 coronary artery bypass surgery) occurred in the usual care group.

Study design

  • Randomized controlled trial, polypill (n=148) vs usual care (n=155), among patients (mean age, ~56 years) attending a community health center in Alabama, December 2015-July 2017.
  • Polypill (daily): atorvastatin (10 mg), amlodipine (2.5 mg), losartan (25 mg), hydrochlorothiazide (12.5 mg).
  • Funding: American Heart Association; NIH. 

Limitations

  • Open-label design.
  • Single center.