Fixed and free combinations of antihypertensive drugs: adherence to treatment and impact on cardiovascular outcomes. Literature review

Arterial hypertension (HTN) remains the leading risk factor for cardiovascular diseases and premature mortality worldwide. To achieve the target blood pressure (BP) levels, most patients require combination therapy. Current Russian and international clinical guidelines support the preferential use of fixed combinations (FC) in the treatment of patients with HTN. Comparative studies aim to solve the question whether FC is superior or inferior to free (separate) combinations (SC) in terms of effectiveness and safety. This article discusses issues related to the comparison of FC versus SC of antihypertensive drugs for the effective BP control, adherence to therapy, and the impact on the risks of cardiovascular complications and mortality. FC were shown to be an effective strategy for BP control and reducing cardiovascular risk, especially in patients with low adherence to treatment. However, SC therapy remains preferable when personalized treatment is needed. Therefore, the rational choice of antihypertensive therapy requires consideration of the specific clinical situation and individual risk factors.