Optimization of blood pressure-lowering treatment with the web-based application mniejlekow.pl to increase single-pill combination use: real-world evidence from the MNIEJ LEKÓW Study

Background. Single-pill combinations (SPCs) comprise the basis of effective blood-lowering treatment but they remain underused in Poland. This study assessed whether single use of mniejlekow.pl — a free web-based tool identifying available SPC equivalents of multiple-pill regimens, changes real-world antihypertensive drugs prescribing. Material and methods. MNIEJ LEKÓW was a prospective, non-interventional study conducted between November 2025 and April 2026 by 199 outpatient cardiologists and hypertension specialists. Adult patients treated with at least two antihypertensive drug classes and with documented treatment modification within the preceding 24 months were enrolled during a single routine visit. Two drug regimens were compared: before and after the visit during which physicians were asked to review blood pressure-lowering therapy using the web-based tool mniejlekow.pl. The primary endpoint was the change in the number of antihypertensive tablets per day. Results. The study included 1983 patients (52.5% women; mean age 65 ± 13.1 years; 81.0% with at least one cardiometabolic comorbidity). The tool was used by all physicians during the study visit and shaped the therapeutic decision in 60% of cases where drug regimen was modified. In the whole group, the mean number of blood pressure-lowering tablets was reduced from 2.5 to 2.1 per day (p < 0.001; Cohen’s d = 0.51). The mean number of active blood pressure-lowering substances remained largely unchanged (3 drugs), indicating that tablet reduction was primarily driven by transition to SPCs rather than therapeutic de-escalation. Two-drug SPC use increased from 41.6% to 60.0%, and three-drug SPC use increased from 7.9% to 21.0%; guideline-concordant regimens increased from 49.9% to 73.6%. A higher baseline tablet count [odds ratio (OR) = 5.19] and a tool-based decision (OR = 3.44) independently predicted tablet reduction. Conclusions. A one-time use of the web-based tool mniejlekow.pl was associated with a reduction in patients’ pill burden, achieved primarily by a marked increase in SPC use.