The European Commission (EC)  has approved the Novartis' Rasitrio, the first triple combination of aliskiren, amlodipine and hydrochlorothiazide (HCT) in a single pill, for the treatment of high blood pressure.

"For the first time, high blood pressure patients in Europe with complex needs will have access to a single pill combining the unique properties of Rasilez with two well-established and effective high blood pressure treatments," said David Epstein, Division Head of Novartis Pharmaceuticals. "Rasitrio is the first Rasilez-based triple combination pill available in Europe to help patients requiring multiple medications reach their treatment goal."

Rasitrio combines the first and only approved direct renin inhibitor (DRI) worldwide, Rasilez, with the widely used calcium channel blocker amlodipine and the diuretic hydrochlorothiazide. Rasilez is an important component of the treatment as it targets renin for optimal control of the RAAS (renin angiotensin aldosterone system), which is a key regulator of high blood pressure. Rasitrio has been approved as substitution therapy for patients with high blood pressure that are adequately controlled by the combination of the three components at the same dose.

The approval of Rasitrio is based on pivotal phase III data involving more than 1,181 high blood pressure patients. The study showed that Rasitrio produced statistically significant blood pressure reductions compared to dual combinations of each of its individual components, including aliskiren/amlodipine 300 mg/10 mg, aliskiren/HCTZ 300 mg/25 mg and amlodipine/HCTZ 10 mg/25 mg. The effect of Rasitrio was observed as early as one week after initiation of therapy and was maintained over the entire 24-hour dose interval.

Up to 85 per cent of high blood pressure patients may need several medications to help them reach their goal. However, the management of multiple drugs can lead to compliance concerns, a major challenge for primary care physicians.

"Simplification of treatment for high blood pressure patients on three or more therapies is key to improving patient compliance and outcomes," said Professor Josep Redon, M.D., Hospital Clinico, University of Valencia, Spain. "This innovative triple combination therapy, which has demonstrated significant reductions in blood pressure during clinical trials, offers patients a new and convenient treatment option."

The single pill combination Rasitrio works to lower blood pressure in three ways. The Rasilez component directly binds to and inhibits renin, an enzyme produced by the kidneys that starts a process that can make blood vessels narrow and lead to high blood pressure. The calcium channel blocker amlodipine lowers blood pressure by relaxing the blood vessel walls, and the diuretic hydrochlorothiazide increases the excretion of sodium chloride and water. All three complementary medicines enable blood to flow more easily, therefore lowering blood pressure.

It is estimated that about one billion people globally have high blood pressure, with many remaining uncontrolled despite treatment. High blood pressure alone can cause damage to the vital organs of the body, including the heart, brain and kidneys. It is also linked with other conditions such as diabetes, where high blood pressure is estimated to cause up to 75% of diabetic cardiovascular complications. However, if high blood pressure is properly controlled, the incidence of stroke and heart failure can be reduced by almost half and heart attacks by one quarter.

Tekturna/Rasilez is approved in over 80 countries. Aliskiren was approved in the US and in the European Union in 2007 under the trade name of Tekturna and Rasilez respectively. Rasilez received approval in Canada in 2008, Japan in 2009 and China in March 2010. Tekturna HCT, a single pill combination of aliskiren and hydrochlorothiazide (HCT), was approved in the US in 2008 for second-line treatment of high blood pressure, and in 2009 for first-line treatment of high blood pressure. This single pill combination was approved for add-on and replacement therapy in the European Union in 2009 under the tradename Rasilez HCT.

In 2009, Valturna, a single pill combination of aliskiren and valsartan (Diovan), was approved in the US. Tekamlo, the single pill combination of aliskiren and amlodipine was approved in the US in August 2010 and in the European Union under the trade name Rasilamlo in April 2011. Amturnide, the triple combination of aliskiren, amlodipine and hydrochlorothiazide (HCT), was approved in the US in December 2010.