Real-World Effectiveness and Safety of Ramipril/Indapamide Combination Therapy in Essential Hypertension: A...

This study aimed to evaluate the patient characteristics, effectiveness, safety, adherence, and persistence of ramipril/indapamide (R/I) free combination therapy in patients with essential hypertension inadequately controlled with monotherapy.

This retrospective observational cohort study used anonymized UK primary care electronic health records from IQVIA's Medical Research Database (IMRD), incorporating "The Health Improvement Network" (THIN), a Cegedim Database. Adults with essential hypertension who switched from ramipril or indapamide monotherapy to R/I between database inception and January 1, 2021, were enrolled. Outcomes included changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP), proportions achieving BP < 140/90 mmHg or SBP ≥ 20 mmHg/DBP ≥ 10 mmHg decrease, proportion of days covered (PDC), persistence, and adverse events (AEs) over 12 months.

A total of 1089 patients met inclusion criteria (mean age 63.5 years; 55.6% female). Mean baseline BP on monotherapy was 156.0/89.1 mmHg. Over 12 months, mean SBP decreased by 18.7 mmHg and DBP by 8.9 mmHg (both p < 0.001); 54.3% of patients achieved BP < 140/90 mmHg, and 61.6% met the predefined BP decrease threshold. A dose-response relationship was observed for BP outcomes. Mean PDC was 92.4% at 3 months and 86.2% at 12 months; persistence was 87.7% and 81.5%, respectively. The most frequent AE was cough (10.38%); gout occurred in 0.73%, exclusively in indapamide-naïve patients. The outcomes remained consistent across sensitivity and subgroup analyses.

Switching from ramipril or indapamide monotherapy to their free combination was associated with clinically meaningful BP decreases, high adherence and persistence, and a favorable safety profile in routine practice. These findings are consistent with current therapeutic guidelines that endorse its use in essential hypertension management.