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Canadian Journal of Cardiology

A Single Fixed-Dose Combination for All Patients Is Bad Medicine

  • J. David Spence
    Correspondence
    Corresponding author: Dr J. David Spence, Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, 1400 Western Rd, London, Ontario N6G 2V2, Canada. Tel.: +1-519-931-5731; fax: +1-519-931-5737.
    Affiliations
    Division of Clinical Pharmacology, Department of Medicine, Western University, London, Ontario, Canada

    Robarts Research Institute, London, Ontario, Canada

    Division of Neurology, Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
    Search for articles by this author
Published:February 18, 2014DOI:https://doi.org/10.1016/j.cjca.2014.01.018

      Abstract

      It has been proposed that cardiovascular risk could be markedly reduced by prescribing a single daily pill to all patients at risk. This concept is bad medicine, because each constituent has problems, and the problems are different for each patient. A key principle of clinical pharmacology is individualization of therapy. Patients are not all the same, so a single polypill cannot work for all of them. For patients with resistant hypertension, at least 3 different versions would be needed for patients with different causes of hypertension, and even then not one pill would be suitable for all patients.

      Résumé

      Il a été avancé que le risque cardiovasculaire pourrait nettement être réduit en prescrivant une pilule à prise monoquotidienne à tous les patients exposés à un risque. On ne peut pas dire que ce concept relève de la bonne médecine puisque chaque composant présente des problèmes, et que les problèmes sont différents d’un patient à l’autre. Un principe clé de la pharmacologie clinique est l’individualisation du traitement. Les patients étant tous différents, une seule polypilule ne peut fonctionner pour tous. En ce qui concerne les patients souffrant d’une hypertension artérielle réfractaire, au moins 3 versions différentes seraient nécessaires chez ceux dont les causes d’hypertension artérielle diffèrent, et déjà une seule pilule ne conviendrait pas à tous les patients.
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