Real‐World Effectiveness and Safety of Ramipril/Indapamide Combination Therapy in Essential Hypertension: A Retrospective Study on UK Primary Care Records

Objective: This study aimed to evaluate the patient characteristics, effectiveness, safety, adherence, and persistence of ramipril/indapamide (R/I) free combination therapy in patients with essential hypertension inadequately controlled with monotherapy. Methods: This retrospective observational cohort study used anonymized UK primary care electronic health records from IQVIA's Medical Research Database (IMRD), incorporating "The Health Improvement Network" (THIN), a Cegedim Database. Adults with essential hypertension who switched from ramipril or indapamide monotherapy to R/I between database inception and January 1, 2021, were enrolled. Outcomes included changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP), proportions achieving BP < 140/90 mmHg or SBP ≥ 20 mmHg/DBP ≥ 10 mmHg decrease, proportion of days covered (PDC), persistence, and adverse events (AEs) over 12 months. A dose-response relationship was observed for BP outcomes. Mean PDC was 92.4% at 3 months and 86.2% at 12 months; persistence was 87.7% and 81.5%, respectively. The most frequent AE was cough (10.38%); gout occurred in 0.73%, exclusively in indapamide-naïve patients. The outcomes remained consistent across sensitivity and subgroup analyses. Conclusion: Switching from ramipril or indapamide monotherapy to their free combination was associated with clinically meaningful BP decreases, high adherence and persistence, and a favorable safety profile in routine practice. These findings are consistent with current therapeutic guidelines that endorse its use in essential hypertension management.