Treatment with Free Triple Combination Therapy of Atorvastatin, Perindopril, Amlodipine in Hypertensive Patients: A Real-World Population Study in Italy

Valentina Perrone, Chiara Veronesi, Marco Gambera, Giulio Nati, Francesco Perone, Paola Fausta Tagliabue, Luca Degli Esposti, Massimo Volpe

Research output: Contribution to journalArticlepeer-review


INTRODUCTION: Polytherapy is often required to treat the comorbidity of hypertension and hyperlipidemia. Fixed-dose co-formulation, rather than free combinations, simplifies medication taking and also improves adherence to medication, which is the key for a successful management of these conditions.

AIM: To determine the number of patients potentially eligible for treatment with triple fixed-dose atorvastatin/perindopril/amlodipine (CTAPA), and to estimate if an unmet medical need exists among CTAPA free combination treated patients.

METHODS: This observational retrospective study was based on administrative databases of 3 Italian Local Health Units. The cohort comprised adult patients with at least one prescription of amlodipine and perindopril (either as free combination or co-formulated) and atorvastatin during 2014. Follow-up period started on the date of prescription of the 3 molecules (index date) and lasted 1 year. Adherence to CTAPA was analyzed during follow-up, by using the proportion of days covered (PDC).

RESULTS: 2292 patients (9.1 per 10,000 beneficiaries) had a prescription for CTAPA as free combination. Only 1249 (54.5%) were adherent to the therapy (PDC ≥ 80%); among them, a small percentage required dosage modification. The number of patients with CTAPA increased during the study period. Discontinuation of drugs prescribed the year before interested 582 patients in 2014, and 522 in 2015. Considering the Italian national population (n = 60,782,668), it was estimated that 69,542 hypertensive patients could be eligible for fixed-dose CTAPA during 2014.

CONCLUSIONS: Real-world analysis among patients with free combination therapy can be applied to estimate the eligible population for fixed combination, and to evaluate the appropriateness of their prescriptions. Moreover, fixed-dose CTAPA could effectively improve adherence, which was calculated to be low in the free combination cohort.

Original languageEnglish
Pages (from-to)399-404
Number of pages6
JournalHigh Blood Pressure and Cardiovascular Prevention
Issue number5
Publication statusPublished - Oct 2019


  • Aged
  • Amlodipine/therapeutic use
  • Angiotensin-Converting Enzyme Inhibitors/therapeutic use
  • Antihypertensive Agents/therapeutic use
  • Atorvastatin/therapeutic use
  • Biomarkers/blood
  • Blood Pressure/drug effects
  • Calcium Channel Blockers/therapeutic use
  • Databases, Factual
  • Drug Therapy, Combination
  • Dyslipidemias/blood
  • Female
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use
  • Hypertension/diagnosis
  • Italy
  • Lipids/blood
  • Male
  • Medication Adherence
  • Middle Aged
  • Perindopril/therapeutic use
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome


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