title: [Influence of compliance on the incidence of cardiovascular events and health costs when using single-pill fixed-dose combinations for the treatment of hypertension].
abstract: OBJECTIVE
  To determine the incidence of cardiovascular events (CVE) and health care costs in relation to compliance, persistence and level of blood pressure control when comparing patients treated with single-pill combinations (SPC) or free combinations (FC) for the treatment of hypertension.
  
  
  METHODS
  Observational, multicenter study that included patients>30 years old, from six primary care teams and two hospitals, who started pharmacological treatment for hypertension during 2006. Two study groups were established: SPC (ACEIs/diuretics; ARBs/diuretics) and FC (ACEIs+DIU; ARB+DIU, separately). Main variables studied were sociodemographic data, comorbidity, Charlson-index, compliance, persistence and achievement of therapeutic goals (ESH-ESC criteria). The cumulative incidence of CVE and a total-cost model were determined (differentiating: health/direct; non-health/indirect). Patients were followed for two years. Statistical analysis included logistic regression, Cox proportional hazards model and analysis of covariance. Statistical signification: p<0.05.
  
  
  RESULTS
  1,605 patients were recruited, 1,112 (69.3%) receiving SPC and 493 (30.7%) receiving FC, p<0.001; mean age: 69.4 (12.2) years; women: 55.5%. FC treatments were associated with ischaemic heart disease (OR=1.4; 95% CI: 1.1-2.0) and organ failure (OR=1.5; 95% CI: 1.2-2.1), p<0.031. Patients on SPC showed better therapeutic compliance (77.6% vs 71.9%; p<0.001) and longer persistence of treatment (62.1% on-treatment at 24-months [95% CI: 56.3-67.9] vs 49.7% [95% CI: 38.5-60.9]; p<0.001). Optimal control of blood pressure was higher in SPC (48.9% [95% CI: 43.0-54.8] vs 46.7% [95% CI: 35.6-57.8]; p<0.001). Cumulative incidence of cerebrovascular accidents in FC was 4.6% vs 2.4% in SPC; p=0.041. The total health care costs were lower in SPC (1,650.7 € vs 1,674.8 €; p<0.001), including lower specialized care costs (316.1 € vs 382.9 €; p<0.001), fewer hospital admissions and less loss of labour productivity (44.5 € vs 88.4 €; p<0.001).
  
  
  CONCLUSIONS
  Better compliance and persistence with antihypertensive fixed-dose combinations improves therapeutic control, leading to a significant reduction of cerebrovascular accidents and total health care costs.
authors.affiliation: Dirección de Planificación, Badalona Serveis Assistencials S.A., Badalona, Barcelona, España. asicras@bsa.cat
authors.forename: Antoni
authors.initials: A
authors.lastname: Sicras Mainar
authors.forename: Jordi
authors.initials: J
authors.lastname: Galera Llorca
authors.forename: Genís
authors.initials: G
authors.lastname: Muñoz Ortí
authors.forename: Ruth
authors.initials: R
authors.lastname: Navarro Artieda
mesh_terms: D000041:Absenteeism; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000145:classification / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000191:economics / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D015897:Comorbidity; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics; D006782:Hospitals, Special / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D015994:Incidence; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011320:Primary Health Care; D018570:Risk Assessment; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000191:economics / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D013607:Tablets
chemical_list: D000959:Antihypertensive Agents; D004338:Drug Combinations; D013607:Tablets