The efficacy and tolerability of 'polypills': meta-analysis of randomised controlled trials.

<h4>Background</h4>To assess the blood pressure and lipid-lowering efficacy and tolerability of 'polypills' used in cardiovascular disease prevention trials.<h4>Methodology/principal findings</h4>Systematic review and meta-analysis.<h4>Search strategy</h4&g...

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Autores principales:	C Raina Elley, Ajay K Gupta, Ruth Webster, Vanessa Selak, Min Jun, Anushka Patel, Anthony Rodgers, Simon Thom
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/6ef7b97ce2e5434e8367138d67602e7c
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spelling	oai:doaj.org-article:6ef7b97ce2e5434e8367138d67602e7c2021-11-18T08:04:29ZThe efficacy and tolerability of 'polypills': meta-analysis of randomised controlled trials.1932-620310.1371/journal.pone.0052145https://doaj.org/article/6ef7b97ce2e5434e8367138d67602e7c2012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23284906/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>To assess the blood pressure and lipid-lowering efficacy and tolerability of 'polypills' used in cardiovascular disease prevention trials.<h4>Methodology/principal findings</h4>Systematic review and meta-analysis.<h4>Search strategy</h4>The Cochrane Central Register of Controlled Trials, Medline, and PubMed databases were searched for eligible trials. Study inclusion criteria: Randomised controlled trials of at least six weeks duration, which compared a 'polypill' (that included at least one anti-hypertensive and one lipid-lowering medication) with a placebo (or one active component).<h4>Outcome measures</h4>Change from baseline in systolic and diastolic blood pressures, and total and LDL-cholesterol; discontinuation of study medication and reported adverse effects. Of 44 potentially eligible studies, six trials (including 2,218 patients without previous cardiovascular disease) fulfilled the inclusion criteria. Compared with placebo, 'polypills' reduced systolic blood pressure by -9.2 mmHg (95% confidence interval (CI): -13.4, -5.0) diastolic blood pressure by -5.0 mmHg (95%CI: -7.4, -2.6), total cholesterol by -1.22 mmol/L (95%CI: -1.60, -0.84) and LDL-cholesterol by -1.02 mmol/L (95%CI: -1.37, -0.67). However, those taking a 'polypill' (vs. placebo or component) were more likely to discontinue medication (20% vs 14%) (Odds ratio: 1.5 (95% CI: 1.2, 1.9)). There was no significant difference in reported adverse effects amongst those on a 'polypill' (36% vs. 28%) (OR: 1.3 (95%CI: 0.7, 2.5)). There was high statistical heterogeneity in comparisons for blood pressure and lipid-lowering but use of random-effects and quality-effects models produced very similar results.<h4>Conclusions/significance</h4>Compared with placebo, the 'polypills' reduced blood pressure and lipids. Tolerability was lower amongst those on 'polypills' than those on placebo or one component, but differences were moderate. Effectiveness trials are needed to help clarify the status of 'polypills' in primary care and prevention strategies.C Raina ElleyAjay K GuptaRuth WebsterVanessa SelakMin JunAnushka PatelAnthony RodgersSimon ThomPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 12, p e52145 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q C Raina Elley Ajay K Gupta Ruth Webster Vanessa Selak Min Jun Anushka Patel Anthony Rodgers Simon Thom The efficacy and tolerability of 'polypills': meta-analysis of randomised controlled trials.
description	<h4>Background</h4>To assess the blood pressure and lipid-lowering efficacy and tolerability of 'polypills' used in cardiovascular disease prevention trials.<h4>Methodology/principal findings</h4>Systematic review and meta-analysis.<h4>Search strategy</h4>The Cochrane Central Register of Controlled Trials, Medline, and PubMed databases were searched for eligible trials. Study inclusion criteria: Randomised controlled trials of at least six weeks duration, which compared a 'polypill' (that included at least one anti-hypertensive and one lipid-lowering medication) with a placebo (or one active component).<h4>Outcome measures</h4>Change from baseline in systolic and diastolic blood pressures, and total and LDL-cholesterol; discontinuation of study medication and reported adverse effects. Of 44 potentially eligible studies, six trials (including 2,218 patients without previous cardiovascular disease) fulfilled the inclusion criteria. Compared with placebo, 'polypills' reduced systolic blood pressure by -9.2 mmHg (95% confidence interval (CI): -13.4, -5.0) diastolic blood pressure by -5.0 mmHg (95%CI: -7.4, -2.6), total cholesterol by -1.22 mmol/L (95%CI: -1.60, -0.84) and LDL-cholesterol by -1.02 mmol/L (95%CI: -1.37, -0.67). However, those taking a 'polypill' (vs. placebo or component) were more likely to discontinue medication (20% vs 14%) (Odds ratio: 1.5 (95% CI: 1.2, 1.9)). There was no significant difference in reported adverse effects amongst those on a 'polypill' (36% vs. 28%) (OR: 1.3 (95%CI: 0.7, 2.5)). There was high statistical heterogeneity in comparisons for blood pressure and lipid-lowering but use of random-effects and quality-effects models produced very similar results.<h4>Conclusions/significance</h4>Compared with placebo, the 'polypills' reduced blood pressure and lipids. Tolerability was lower amongst those on 'polypills' than those on placebo or one component, but differences were moderate. Effectiveness trials are needed to help clarify the status of 'polypills' in primary care and prevention strategies.
format	article
author	C Raina Elley Ajay K Gupta Ruth Webster Vanessa Selak Min Jun Anushka Patel Anthony Rodgers Simon Thom
author_facet	C Raina Elley Ajay K Gupta Ruth Webster Vanessa Selak Min Jun Anushka Patel Anthony Rodgers Simon Thom
author_sort	C Raina Elley
title	The efficacy and tolerability of 'polypills': meta-analysis of randomised controlled trials.
title_short	The efficacy and tolerability of 'polypills': meta-analysis of randomised controlled trials.
title_full	The efficacy and tolerability of 'polypills': meta-analysis of randomised controlled trials.
title_fullStr	The efficacy and tolerability of 'polypills': meta-analysis of randomised controlled trials.
title_full_unstemmed	The efficacy and tolerability of 'polypills': meta-analysis of randomised controlled trials.
title_sort	efficacy and tolerability of 'polypills': meta-analysis of randomised controlled trials.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/6ef7b97ce2e5434e8367138d67602e7c
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The efficacy and tolerability of 'polypills': meta-analysis of randomised controlled trials.

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