Hypertension

Chronic Condition Management

Tip of the Month

Message from the Medical Director

In this month's issue, we focus on the benefits of single-pill combination therapy in patients with hypertension to improve adherence and blood pressure control.

Patients are more likely to comply with their treatment when prescribed single-pill combinations — and given that a systolic BP decrease of 10 mmHg associated with a 20-30% decrease in cardiovascular risk the stakes are high when it comes to medication adherence.

I encourage you to read the published studies and clinical takeaways below that you can apply in your practice to treat your patients living with hypertension.

Thank you for your commitment to deliver high-quality care to our patients and in support of their health

Kind regards,

X. Shirley Chen, MD, MS

In this Issue

MSHS-Nephrology-KidneyTransplantation-2col-770x420 image

Single-pill combination therapy initiation
Other considerations in drug therapy
Updated resources for managing hypertension

Clinical Takeaways

Use single-pill combinations as a first line of pharmacologic treatment for hypertension

The literature has demonstrated that patients on single-pill combination (SPC) therapy for hypertension are more likely to comply with their medication regimen. Improved adherence and persistence are likely to improve blood pressure (BP) control.

Adherence to Single-Pill Versus

Free-Equivalent Combination Therapy in Hypertension*

*Source

The majority (18 of 23) of studies measuring adherence showed adherence was significantly improved in patients receiving SPCs versus free equivalent combinations

Single Pill Combination Tablets

(Click here to view the full medication list)

Dosing Ranges

ACE Inhibitor or ARB + Diuretic

Losartan-HCTZ*	50-12.5 mg, 100-12.5 mg, 100-25 mg
Lisinopril-HCTZ*	10-12.5 mg, 20-12.5 mg, 20-25 mg
Valsartan-HCTZ*	80-12.5 mg, 160-12.5 mg, 160-25 mg, 320-12.5 mg, 320-25 mg
Benazepril-HCTZ*	10-12.5 mg, 20-12.5 mg, 20-25 mg
Captopril-HCTZ*	25-15 mg, 25-25 mg, 50-15 mg, 50-25 mg
Enalapril-HCTZ*	5-12.5 mg, 10-25 mg

ACE Inhibitor or ARB + CCB

Amlodipine-Benazepril*

2.5-10 mg, 5-10 mg, 5-20 mg, 5-40 mg, 10-20 mg, 10-20 mg,10-40 mg

Amlodipine-Valsartan*

5-160 mg, 5-320 mg, 10-160 mg,

10-320 mg

Beta Blocker + Diuretic

Atenolol-Chlorthalidone*	50-25mg, 100-25mg
Bisoprolol-HCTZ*	2.5-6.25 mg, 5-6.25mg, 10-6.25 mg

K-Sparing Diuretic + Thiazide Diuretic

Triamterene-HCTZ*

Capsules: 37.5-25mg

Tablets: 37.5-25mg, 75-50mg

Amiloride-HCTZ*

5-50mg

Spironolactone-HCTZ*

25-25mg

*All medications in this table do not require prior authorization per Medicaid NYRx.

Other Considerations in Drug Therapy

Avoid Hypotension

For patients with low-risk Stage 1 hypertension and in patients aged >80 years or frail, consider less aggressive blood pressure targets to avoid hypotension

Strategies for Adherence

Simplify regimen with once daily dosing and single pill combinations
Consider initial therapy with SPC for all patients with hypertension, especially those with BP > 160/100 mmHg or 20/10 mmHg above goal
Consider prescribing 90-day supplies

Medication Titration and Additions

Initiating a second agent before titration of the first agent may result in a larger reduction in blood pressure compared with increasing the dose of the first agent
When adding second agent, consider ARB for most patients given lower risk of angioedema and less drug-induced cough
If on HCTZ, you may also consider switching to more potent diuretic (chlorthalidone) if still above goal, considering renal function and potassium
Chlorthalidone is not available in combination with first line agents, so you may consider alternative SPC with ACEi/ARB-CCB + chlorthalidone

Updated Resources for Managing Hypertension

Newly Updated! Mount Sinai Hypertension Care Pathway and Quick Reference Guide

The Mount Sinai Hypertension Ambulatory Care Pathway and Quick Reference Guide are now updated with new information you need to know:

Updated hypertension staging thresholds from the American Heart Association
Single-pill combinations as the first line of pharmacological treatment whenever available as they are associated with better adherence and persistence than multi-pill regimens
Removal of “race-based” pharmacologic treatment recommendations and replaced with guidance for providers to consider all factors in treatment for high risk populations

Plus, you'll find information on diagnosis and evaluation, treatment targets and recommendations and when to refer to specialty care.

Download today!

Hypertension Care Pathway

Hypertension Quick Guide

Find more on the Chronic Condition Management Hub

Mount Sinai Health System's Chronic Condition Management Hub is an online resource center for primary care physicians, specialists, and other care providers with resources and information to help them manage chronic health conditions

P: 877-234-6667

E: MSHP@mountsinai.org

Provider Engagement Team