Clinical Efficacy of Polypill with a Focus on Blood Pressure Control: A Systematic Review and Meta-analysis

The effectiveness of controlling blood pressure when prescribing a fixed combination ("polypill") compared to monocomponent drugs has not been fully determined. According to the studies conducted, some demonstrate statistically significant differences in mean blood pressure levels when taking a "polypill" compared to monocomponent drugs, while others do not reveal this effect. The aim was to evaluate the efficacy of "polypill" in lowering blood pressure in patients with Cardiovascular (CV) diseases compared to monocomponent drugs.

The search was conducted according to PRISMA guidelines in PubMed, Google Scholar, and ClinicalTrials databases. Finally, 10 studies were selected. The dynamics of the mean systolic and diastolic pressure in patients taking "polypill" was evaluated in comparison to monocomponent drugs.

During the identification stage, 568 publications were found. At the screening phase, 321 papers, such as books, reviews, systematic reviews, meta-analyses, etc were excluded. 168 papers were assessed for eligibility. After the eligibility assessment, 158 papers were excluded for deviations from the study design (e.g., no control group, no direct comparison between "polypill" and monocomponent drug therapy, data presented as median and interquartile range, placebo as the control group, etc.). In the final analysis, we included 10 publications that evaluated the effect of a fixed combination of medications ("polypill") compared with monocomponent therapy on blood pressure. During further sub-analyses, 1 study was excluded. The meta-analysis of the clinical efficacy of "polypill" control of blood pressure was conducted in comparison with standard therapy and comprised 9 studies, involving patients with previous myocardial infarction, acute cerebrovascular accident, high CV risk, hypertension and dyslipidemia. In total, all of the studies enrolled 6264 people, of whom 3147 patients received "polypill", and 3117 patients - monocomponent drugs. The meta-analysis demonstrated that fixed-dose combination therapy yielded a statistically significant difference compared to standard therapy with respect to its impact on systolic (standardized mean difference: -0.128; (-0.177; -0.08); p < 0.01) and diastolic (standardized mean difference: -0.171; (-0.233; -0.11); p < 0.01) blood pressure.

The findings of the conducted meta-analysis support the evidence of beneficial switching to "polypill" therapy in patients with hypertension, especially in cases requiring a multi-drug regimen.

"Polypill" therapy in patients with CV diseases, hypertension, dyslipidemia, and high CV risk is associated with more effective blood pressure control compared to monocomponent drugs.