Impact on Global Cardiovascular Risk of Early Use of Anti-Hypertensive and Lipid-Lowering Therapy in Fixed-Combination: Practical Implications of the Guidelines Recommendations

Objective: The 2018 ESH/ESC guidelines for the management of arterial hypertension strongly recommended the use of single-pill combination therapy as first-line treatment, approach confirmed also in the recent 2023 ESH guidelines. On the contrary, the 2019 ESC guidelines for the management of dyslipidemia recommended a stepwise treatment approach. This strategy is also applied in Italy through AIFA note 13, a regulatory tool which defines prescription and reimbursement of lipid-lowering drugs by the National Health Service. The aim of the study was to evaluate prospectively the effects of anti-hypertensive (HTT) and lipid-lowering therapy (LLT) in fixed-combination on global cardiovascular (CV) risk, in a group of hypertensive and dyslipidemic patients in primary prevention. Design and method: 143 patients (mean age 60.2±10.9 years, 49% male) were consecutively enrolled in our center from 2018 to 2022. The subjects were defined hypertensives for systolic blood pressure (SBP) and/or diastolic blood pressure (DBP) values >140/90 mmHg or in HTT, and dyslipidemic for non-HDL cholesterol values >130 mg/dL or in LLT. CV risk was calculated at baseline and at 1-year of follow-up with SCORE-2 and SCORE-2 OP algorithm, after starting anti-hypertensive (at the morning) and lipid-lowering therapy (after lunch) in single-pill combination. Categorical variables were compared with the X2 test while differences between continuous variables were evaluated by the analysis of variance for repeated measures. The prevalence of independent predictors of improvement vs. worsened/stable in SCORE-2 risk was assessed by the Poisson regression analysis. Results: SCORE-2 improved in 69.9% of cases. Adherence to treatment was 94%. Modification of antihypertensive and lipid-lowering therapy, reduction in SBP of 5 mmHg and adherence to treatment independently predicted the improvement in SCORE-2 (Figure). On the contrary, obesity and mild chronic renal failure (CKD) were associated with a worsening in SCORE-2. Conclusions: The early use of both HTT and LLT in fixed combination seems to improve in the medium-term the global CV risk. Therapeutic adherence has the same impact on CV risk as the modification of anti-hypertensive and lipid-lowering therapy.