Antihypertensive Drugs in an Iranian Population, Prevalence and Variety of Single Pill Combination (SPC)

Abstract

Background: Hypertension (HTN) is a major global health concern and a leading risk factor for conditions such as coronary artery disease (CAD), stroke, and chronic kidney disease. Recent advancements have led to the development of single-pill combinations (SPCs) of antihypertensive medications, which aim to improve patient adherence and outcomes. Objectives: This study investigates the consumption patterns of SPCs among hypertensive patients in eastern Iran. Patients and Methods: This cross-sectional study involved 1,208 hypertensive patients treated by cardiologists, internists, or general practitioners (GPs) between December 2022 and September 2023 in Birjand, located in the east of Iran. Demographic data, medical history, and details regarding antihypertensive medication usage—specifically types and dosages—were collected by trained nursing staff. Data analysis was performed using SPSS software version 22.0. Chi-square tests and Fisher's exact tests were utilized (P ≤ 0.05). Results: The participants had a mean age of 62.6 ± 10.3 years, with 63% being women, 86.6% residing in urban areas, and 30% holding a university degree. The predominant treatment among patients was monotherapy, primarily using angiotensin receptor blockers (ARBs) such as losartan. Only 11% of patients were utilizing SPCs. Combination therapies were significantly more common among patients with concurrent CAD (39.1% monotherapy vs. 43.7% combination therapy, P < 0.001), heart failure (17.5% monotherapy vs. 77.5% combination therapy, P = 0.05), obesity, higher education levels, and urban residency. Additionally, GPs prescribed monotherapy more frequently than internists and cardiologists. The study identified only two types of combined SPCs in use: ARB + Calcium Channel Blocker (CCB) and ARB + diuretic. Conclusions: The findings indicate that only one-tenth of hypertensive patients in this study were prescribed SPCs. General practitioners favored monotherapy more than specialists, and the variety of SPCs available in Iran appears limited. These results underscore the need for enhanced educational efforts to improve physicians' understanding of SPCs. Furthermore, pharmaceutical companies have an opportunity to develop more diverse SPCs by combining various antihypertensive drug categories.