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Single pill with two drugs could transform blood pressure treatment

Use of a single pill containing two drugs could transform management of high blood pressure, according to new guidelines.

The European Society of Cardiology (ESC) and European Society of Hypertension guidelines announced over the weekend could lead to massive reductions in strokes, heart disease and early deaths, doctors predict.

High blood pressure is the leading cause of death worldwide, and 30-45% of adults are affected.

The guidelines recommend starting most patients on two blood pressure lowering drugs, not one.

The previous recommendation was for step-wise treatment, which meant starting with one drug then adding a second and third if needed.

But this suffered from ‘physician inertia’, where doctors were reluctant to change the initial strategy despite its lack of success. At least 80% of patients should have been upgraded to two drugs, yet most remained on one. Two pills also increases non-adherence. 

The new guidelines also lower blood pressure targets for all ages.

Our BRC director Professor Bryan Williams, who is chair of the ESC guidelines task force, said: ‘The vast majority of patients with high blood pressure should start treatment with two drugs as a single pill. These pills are already available and should massively improve the success of treatment.’

Lowering blood pressure targets for all ages would mean patients who previously only received lifestyle advice should now be given drugs.

‘Many more millions of people, particularly in the older age groups, should be receiving treatment for high blood pressure’, Professor Williams said.

A healthy blood pressure reading is below 120/80 mmHg, and anyone between 65-80 years old with a reading above 140/90 mmHg is advised to see their doctor.

A healthy lifestyle is recommended for all patients, regardless of blood pressure. Advice includes salt restriction, alcohol moderation, healthy eating, regular exercise, weight control, smoking cessation, and a recommendation to avoid binge drinking.