Polypill

What is the most appropriate population to target, what is the potential impact of a ‘polypill’ strategy, and how acceptable is that to patients and health care professionals?

Over 100,000 people in England have a stroke every year. Many die - stroke is responsible for 1 in 10 of all deaths - and many survive with significant disability. Optimal management of blood pressure and blood cholesterol could reduce this burden of stroke by as much as 50%. Treatment of these factors in people who have already had a stroke is particularly important, because such people have a high risk of having another one. Most management of blood pressure (BP) and blood cholesterol in people who have had a stroke is the responsibility of the general practitioner (GP), yet much of the evidence on which GPs need to base their treatment is derived from studies carried out in people who are under the care of specialists. Guidelines recommend that these risk factors are controlled to specific target levels, however surveys show that treatment by general practitioners is generally below the standard recommended. This may be because of uncertainties as to whether the evidence applies to general practice populations, or because better methods are needed to help general practitioners achieve the targets recommended in the guidelines. One way in which care might be improved is to use a fixed dose combination ‘‘polypill’’ rather than to aim to titrate individual treatments to specific BP and cholesterol targets. The aim of this project is to explore the potential role of a ‘polypill’ that combines blood pressure and cholesterol lowering drugs. A series of linked studies will identify the most appropriate population to target, and test feasibility, acceptability and potential impact through analysis of GP electronic data, screening for cardiovascular risk, qualitative and modelling work. This project will provide the data needed to design a pilot randomised controlled trial (RCT) that will test the effectiveness and cost-effectiveness of treatment to target of cholesterol and BP, as compared to using fixed doses of statins and BP lowering agents (‘polypill’ strategy). Approximately 20 practices in the UK will participate.

Investigators:

J Mant, Professor of Primary Care Stroke Research
RJ McManus, Clinical Senior Lecturer
K Fletcher, Programme Manager
S Greenfield, Senior Lecturer
S Bryan, Professor of Health Economics
FDR Hobbs, Professor