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We thank Hofstetter and colleagues [1] for their interest in the position paper we published in the Journal of Hypertension on behalf of the European Society of Hypertension [2]. We agree with their point that there is no obvious reason why among the 15 polypills under development, the vast majority, that is 13, include an angiotensin-converting enzyme inhibitor (ACEI) and only two assign to an AT1 blockers (ARB) the blood pressure (BP) lowering component of a polypill. This is because meta-analyses of randomized trials comparing ACEIs and ARBs have not shown cardiovascular morbidity and mortality to differ significantly between these treatments [3]. It is also because cost is now no more a major factor in the choice, given that not only ACEIs but also ARBs are available in generic form. It is finally because, as Hofstetter et al.[1] correctly emphasize, ARB have the best tolerability profile among available antihypertensive drug classes. As side effects are the major cause of treatment discontinuation [4], this accounts for the evidence that discontinuation is less with ARB than with ACEI treatment, a clinically relevant phenomenon because treatment discontinuation leads to a substantial increase of cardiovascular risk and mortality [5].

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