The practical benefits of SPC combination therapy, or how to improve patient adherence? Clinical case studies Case report
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Published:
Nov 30, 2025
Keywords:
single-pill combination, SPC, adherence to therapy, heart failure, hypertension, chronic coronary syndrome, ACE inhibitor, β-adrenergic blocker
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Abstract
Fixed-dose single-pill combination therapy has long been a mainstay of hypertension management, enabling more rapid attainment of treatment targets and improving long-term outcomes. Single-pill combinations are increasingly employed in other indications as well, such as the treatment of dyslipidaemia and heart failure. The spectrum of available combinations is expanding – beyond the traditional pairings of renin–angiotensin system blockers with calcium-channel blockers or thiazide/thiazide-like diuretics, new options are being introduced. One combination that may be a valuable choice in selected clinical scenarios is a single-pill angiotensin-converting enzyme inhibitor with a β-adrenergic blocker. This article presents two clinical cases in which a ramipril–bisoprolol single-pill combination proved advantageous, substantially improving medication adherence and treatment effectiveness.
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How to Cite
Janiszewski, M., & Kuch, M. (2025). The practical benefits of SPC combination therapy, or how to improve patient adherence? Clinical case studies. Medycyna Faktow (J EBM), 18(3(68), 455-459. https://doi.org/10.24292/01.MF.0325.17
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References
1. McEvoy JW, McCarthy CP, Bruno RM et al. ESC Scientific Document Group 2024 ESC guidelines for the management of elevated blood pressure and hypertension: Developed by the task force on the management of elevated blood pressure and hypertension of the European Society of Cardiology (ESC) and endorsed by the European Society of Endocrinology (ESE) and the European Stroke Organisation (ESO) Eur Heart J. 2024; 45(38): 3912-4018.
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.
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.