Praktyczne korzyści terapii złożonej SPC, czyli jak poprawić przestrzeganie zaleceń przez pacjentów? Studium przypadków klinicznych Opis przypadku
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Opublikowane:
lis 30, 2025
Słowa kluczowe:
preparat złożony, SPC, przestrzeganie zaleceń, niewydolność serca, przewlekły zespół wieńcowy, nadciśnienie tętnicze, inhibitor konwertazy, lek β-adrenolityczny
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Abstrakt
Terapia skojarzona oparta na preparatach złożonych od lat jest podstawą leczenia nadciśnienia tętniczego i przyczynia się do szybszego osiągania celów terapeutycznych i poprawy długoterminowych wyników terapii. Coraz częściej sięga się po stosowanie leków w formie preparatów złożonych również w innych wskazaniach, np. w terapii zaburzeń lipidowych czy leczeniu niewydolności serca. Poszerza się również spektrum dostępnych połączeń lekowych – do klasycznych zestawień łączących leki blokujące układ renina–angiotensyna–aldosteron z antagonistami kanałów wapniowych czy diuretykami tiazydowymi/tiazydopodobnymi dołączają nowe. Połączeniem, które w wybranych sytuacjach klinicznych może być wartościowym wyborem, jest zestawienie w jednej tabletce inhibitora konwertazy i leku β-adrenolitycznego. W artykule przedstawiono dwa przypadki kliniczne, w których wykorzystanie zestawienia ramiprylu i bisoprololu okazało się korzystne i znacząco poprawiło przestrzeganie zaleceń i efekty leczenia.
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Jak cytować
Janiszewski, M., & Kuch, M. (2025). Praktyczne korzyści terapii złożonej SPC, czyli jak poprawić przestrzeganie zaleceń przez pacjentów? Studium przypadków klinicznych. Medycyna Faktów , 18(3(68), 455-459. https://doi.org/10.24292/01.MF.0325.17
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Bibliografia
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4. Rea F, Savare L, Franchi M et al. Adherence to Treatment by Initial Antihypertensive Mono and Combination Therapies. Am J Hypertens. 2021; 34: 1083-91.
5. Schmieder RE, Wassmann S, Predel HG et al. Improved persistence to medication, decreased cardiovascular events and reduced all-cause mortality in hypertensive patients with use of single-pill combinations: results from the START-study. Hypertension. 2023; 80: 1127-35.
6. Persu A, Lopez-Sublet M, Algharably EAE et al. Starting antihypertensive drug treatment with combination therapy: controversies in hypertension – pro side of the argument. Hypertension. 2021; 77: 800-5.
7. Kamat SA, Bullano MF, Chang CL et al. Adherence to single-pill combination versus multiple-pill combination lipid-modifying therapy among patients with mixed dyslipidemia in a managed care population. Curr Med Res Opin. 2011; 27: 961-8.
8. Rea F, Savaré L, Corrao G et al. Adherence to Lipid-Lowering Treatment by Single-Pill Combination of Statin and Ezetimibe. Adv Ther. 2021; 38: 5270-85.
9. Vrints C, Andreotti F, Koskinas KC et al.; ESC Scientific Document Group. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024; 45(36): 3415-537.
10. Virani SS, Newby LK, Arnold SV et al.; Peer Review Committee Members. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2023; 148(9): e9-e119.
11. Castellano JM, Sanz G, Peñalvo JL et al A polypill strategy to improve adherence: results from the FOCUS project. J Am Coll Cardiol. 2014; 64(20): 2071-82.
12. Lopez-Lopez JP, Gonzalez AM, Lanza P et al. Benefits of the Polypill on Medication Adherence in the Primary and Secondary Prevention of Cardiovascular Disease: A Systematic Review. Vasc Health Risk Manag. 2023; 19: 605-15. 1
13. Tan JP, Cheng KKF, Siah RC. A systematic review and meta-analysis on the effectiveness of education on medication adherence for patients with hypertension, hyperlipidaemia and diabetes. J Adv Nurs. 2019; 75(11): 2478-94.
14. Zhou X, Zhang X, Gu N et al. Barriers and Facilitators of Medication Adherence in Hypertension Patients: A Meta-Integration of Qualitative Research. J Patient Exp. 2024; 11: 23743735241241176.
15. Zeijen V, Peeters L, Asman A et al. Quality-of-life and beliefs about medication in relation to a therapy adherence intervention in resistant hypertension: the Resistant HYpertension: MEasure to ReaCh Targets trial. J Hypertens. 2024; 42(10): 1687-94.
16. Heart Outcomes Prevention Evaluation Study Investigators; Yusuf S, Sleight P, Pogue J et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000; 342: 145-53.
17. Bangalore S, Fakheri R, Wandel S et al. Renin angiotensin system inhibitors for patients with stable coronary artery disease without heart failure: systematic review and meta-analysis of randomized trials. BMJ. 2017; 356: j4.
18. Shu DF, Dong BR, Lin XF et al. Long-term beta blockers for stable angina: systematic review and meta-analysis. Eur J Prev Cardiol. 2012; 19: 330-41.
19. Dahl Aarvik M, Sandven I, Dondo TB et al. Effect of oral beta-blocker treatment on mortality in contemporary post-myocardial infarction patients: a systematic review and meta-analysis. Eur Heart J Cardiovasc Pharmacother. 2019; 5: 12-20.
20. The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet. 1999; 353(9146): 9-13.
2. Zambon A, Liberopoulos E, Dovizio M et al. A real-world analysis of adherence, biochemical outcomes, and healthcare costs in patients treated with rosuvastatin/ezetimibe as single-pill combination vs. free combination in Italy. Eur Heart J Open. 2024; 4(5): oeae074.
3. McDonagh TA, Metra M, Adamo M et al. ESC Scientific Document Group. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2023; 44(37): 3627-39.
4. Rea F, Savare L, Franchi M et al. Adherence to Treatment by Initial Antihypertensive Mono and Combination Therapies. Am J Hypertens. 2021; 34: 1083-91.
5. Schmieder RE, Wassmann S, Predel HG et al. Improved persistence to medication, decreased cardiovascular events and reduced all-cause mortality in hypertensive patients with use of single-pill combinations: results from the START-study. Hypertension. 2023; 80: 1127-35.
6. Persu A, Lopez-Sublet M, Algharably EAE et al. Starting antihypertensive drug treatment with combination therapy: controversies in hypertension – pro side of the argument. Hypertension. 2021; 77: 800-5.
7. Kamat SA, Bullano MF, Chang CL et al. Adherence to single-pill combination versus multiple-pill combination lipid-modifying therapy among patients with mixed dyslipidemia in a managed care population. Curr Med Res Opin. 2011; 27: 961-8.
8. Rea F, Savaré L, Corrao G et al. Adherence to Lipid-Lowering Treatment by Single-Pill Combination of Statin and Ezetimibe. Adv Ther. 2021; 38: 5270-85.
9. Vrints C, Andreotti F, Koskinas KC et al.; ESC Scientific Document Group. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024; 45(36): 3415-537.
10. Virani SS, Newby LK, Arnold SV et al.; Peer Review Committee Members. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2023; 148(9): e9-e119.
11. Castellano JM, Sanz G, Peñalvo JL et al A polypill strategy to improve adherence: results from the FOCUS project. J Am Coll Cardiol. 2014; 64(20): 2071-82.
12. Lopez-Lopez JP, Gonzalez AM, Lanza P et al. Benefits of the Polypill on Medication Adherence in the Primary and Secondary Prevention of Cardiovascular Disease: A Systematic Review. Vasc Health Risk Manag. 2023; 19: 605-15. 1
13. Tan JP, Cheng KKF, Siah RC. A systematic review and meta-analysis on the effectiveness of education on medication adherence for patients with hypertension, hyperlipidaemia and diabetes. J Adv Nurs. 2019; 75(11): 2478-94.
14. Zhou X, Zhang X, Gu N et al. Barriers and Facilitators of Medication Adherence in Hypertension Patients: A Meta-Integration of Qualitative Research. J Patient Exp. 2024; 11: 23743735241241176.
15. Zeijen V, Peeters L, Asman A et al. Quality-of-life and beliefs about medication in relation to a therapy adherence intervention in resistant hypertension: the Resistant HYpertension: MEasure to ReaCh Targets trial. J Hypertens. 2024; 42(10): 1687-94.
16. Heart Outcomes Prevention Evaluation Study Investigators; Yusuf S, Sleight P, Pogue J et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000; 342: 145-53.
17. Bangalore S, Fakheri R, Wandel S et al. Renin angiotensin system inhibitors for patients with stable coronary artery disease without heart failure: systematic review and meta-analysis of randomized trials. BMJ. 2017; 356: j4.
18. Shu DF, Dong BR, Lin XF et al. Long-term beta blockers for stable angina: systematic review and meta-analysis. Eur J Prev Cardiol. 2012; 19: 330-41.
19. Dahl Aarvik M, Sandven I, Dondo TB et al. Effect of oral beta-blocker treatment on mortality in contemporary post-myocardial infarction patients: a systematic review and meta-analysis. Eur Heart J Cardiovasc Pharmacother. 2019; 5: 12-20.
20. The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet. 1999; 353(9146): 9-13.