title: [Relationship of polymedication in controlling blood pressure: compliance, persistence, costs and incidence of new cardiovascular events].
abstract: OBJECTIVE
  To determine the relationship of polypharmacy on blood pressure (BP) control, compliance, persistence, the cost and incidence of cardiovascular events (CVD) in patients with moderate/severe hypertension.
  
  
  METHODS
  An observational multicenter retrospective study. We evaluated patients > 30 years who started a third antihypertensive treatment during 2004-2006. Depending on the number of chronic medications, we established 3 groups: regular consumption of 3-6 drugs, including between 7-10 and ≥ 11. Top-measures: sociodemographic, comorbidity, BP, compliance and persistence. For each group we determined the incidence of new CVD totals and total costs.
  
  
  RESULTS
  We evaluated 1,906 patients, 765 between 3-6 drugs, 624 between 7-10 and 517 in ≥ 11 (P<.001). Overage age: 69.4 years and 55.5% women. The group of 3-6 drugs showed better BP control (51.8 vs. 47.0 and 41.1%, P<.001), compliance (71.4 vs. 69.9 and 67.1%, P=.017), persistence (50.1 vs. 45.5 and 46.2%, P=.044) and lower incidence of CVD (12.2 vs. 19.7 and 30.2%, P<.001), respectively. The average/unit total costs was 3,369.1 vs. 4,362.1 and € 4,902.3 (P<.001). The presence of CVD was associated with therapy noncompliance (odds ratio [OR] 1.9, 95% confidence interval [95%CI] 1.1 to 3.6) and controlled by the lower BP control (OR 1.4 (95%CI 1.1-2.0) (P < .05). The use of antihypertensive fixed dose has greater compliance (72.8 vs. 68.2%), persistence (64.4 vs. 39.3%) and degree of BP control (52.6 vs. 43, 8%) (p<.001).
  
  
  CONCLUSIONS
  Polypharmacy is associated with lower compliance and persistence to antihypertensive treatment, cardiovascular disease and increased health care costs.
authors: Dirección de Planificación, Badalona Serveis Assistencials S.A., Badalona, Barcelona, España. asicras@bsa.cat
authors: Antoni
authors: A
authors: Sicras Mainar
authors: Genís
authors: G
authors: Muñoz Ortí
authors: Beatriu
authors: B
authors: Font Ramos
authors: Núria
authors: N
authors: Majós Oró
authors: Ruth
authors: R
authors: Navarro Artieda
authors: Jordi
authors: J
authors: Ibáñez Nolla
mesh_terms: D000041:Absenteeism; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015897:Comorbidity; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000706:statistics & numerical data; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D015994:Incidence; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D018803:Models, Economic; D009819:Office Visits / Q000191:economics / Q000706:statistics & numerical data; D010349:Patient Compliance; D019338:Polypharmacy; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents