CONSENSUS DOCUMENTThe use of single-pill combinations as first-line treatment for hypertension: translating guidelines into clinical practiceCampana, Erikaa,b,∗; Cunha, Vitóriac,∗; Glaveckaite, Sigitad,∗; Gruev, Ivane,∗; Lamirault, Guillaumef,g,∗; Lehmann, Elkeh,v,∗; Masi, Stefanoi,j,∗; Mfeukeu Kuate, Lilianek,∗; Mishshenko, Larysal,∗; Ona, Deborah I.D.m,n,∗; Oo, Min Zawo,∗; Tautu, Oana G.F.p,q,∗; Vachulova, Annar,s,∗; Vintila, Ana-Mariap,t,∗; Wolf, Jaceku,∗; Zvartau, Nadezhdav,w,∗; Narkiewicz, Krzysztofu; Laurent, Stephanex,yAuthor Information aHypertension and Lipid Clinic at the State University of Rio de Janeiro bIguaçu University, Brazil cHospital Garcia de Orta, Almada, Portugal dClinic of Cardiovascular Diseases, Institute of Clinical Medicine, Vilnius University Faculty of Medicine, Vilnius, Lithuania eNational Multi-profile Transport Hospital "Tsar Boris III"- Sofia, Bulgaria fUniversité de Nantes, CHU Nantes gCNRS, INSERM, Institut du thorax, F-44000 Nantes, France hMVZ Verbund Dachau, Akademische Lehrpraxis LMU München, Germany iDepartment of Clinical and Experimental Medicine, University of Pisa, Italy jCentre for Cardiovascular Preventions and Outcomes, Institute of Cardiovascular Science, University College London, UK kFaculty of Médecine and Biomedical Sciences, University of Yaoundé, Cameroon lDepartment of Essential Hypertension, State Institution “National Scientific Center M.D. Strazhesko Institute of Cardiology” NAMS of Ukraine, Ukraine mSection of Hypertension, Department of Medicine, St. Luke's Medical Center, Global City, The Philippines nUniversity of the Philippines oDept of Medicine, University of Medicine, Yangon, Myanmar pCarol Davila University of Medicine and Pharmacy qCardiology Department, Clinical Emergency Hospital Bucharest, Bucharest, Romania rDepartment of Cardiology, National Cardiovascular Institute sMedical School, Comenius University, Bratislava, Slovakia tInternal Medicine and Cardiology Department, Coltea Clinical Hospital, Bucharest, Romania uDepartment of Hypertension and Diabetology, Translational Medicine Center, Medical University of Gdańsk, Gdańsk, Poland vAlmazov National Medical Research Centre wITMO University, Saint-Petersburg, Russia xDepartment of Pharmacology, Hopital Europeen Georges Pompidou yParis University, Paris, France Correspondence to Stephane Laurent, Department of Pharmacology and INSERM U 970, Hôpital Européen Georges Pompidou, Assistance Publique – Hôpitaux de Paris, 56, Rue Leblanc, 75015 Paris, France. Tel: +33 1 56 09 39 91; fax: +33 1 56 09 39 92; e-mail: [email protected] Abbreviations: ACE, angiotensin-converting enzyme; ARB, AT1 blocker; CCB, calcium channel blockers; CME, continuing medical education; ESH, European Society of Hypertension; MyHEART, My Hypertension Education and Reaching Target; RAAS, renin–angiotensin–aldosterone system; SPC, single-pill combination Received 3 June, 2020 Revised 26 June, 2020 Accepted 26 June, 2020 Journal of Hypertension: December 2020 - Volume 38 - Issue 12 - p 2369-2377 doi: 10.1097/HJH.0000000000002598 Buy Metrics Abstract The 2008 European Society of Cardiology/European Society of Hypertension guidelines recommend the first-line prescription of two antihypertensive drugs in single-pill combinations (SPCs), also known as fixed-dose combinations, for the treatment of most patients with hypertension. This recommendation is based on a large amount of data, which shows that first-line treatment with SPCs supports reaching blood pressure targets rapidly and reducing cardiovascular outcome risk while keeping the therapeutic strategies as simple as possible and fostering adherence and persistence. As this approach constitutes a big shift from the stepped-care approaches that have been dominant for many years, practicing physicians have expressed concerns about using SPCs as first-line agents. In this review, we will discuss the barriers to the uptake of this recommendation. We will also offer suggestions to reduce the impact of these barriers and address specific concerns that have been raised. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.