Improved Persistence to Medication, Decreased Cardiovascular Events and Reduced All-Cause Mortality in Hypertensive Patients with Use of Single-Pill Combinations: Results from the START-Study

Schmieder R, Wassmann S, Predel HG, Weisser B, Blettenberg J, Gillessen A, Randerath O, Mevius A, Wilke T, Böhm M (2023)

Publication Type: Journal article

Publication year: 2023

Journal

Hypertension American Heart Association

Book Volume: 80

Pages Range: 1127-1135

Journal Issue: 5

DOI: 10.1161/HYPERTENSIONAHA.122.20810

Abstract

Background: Single-pill combination improves adherence and persistence to medication in hypertension. It remains unclear whether this also reduces cardiovascular outcomes and all-cause mortality. We analyzed whether single-pill combinations are superior to identical multiple pills on persistence to medication, cardiovascular outcomes, and all-cause mortality. Methods: This was a retrospective claims data (German AOK PLUS) analysis. Data from hypertensive patients ≥18 years treated with renin-angiotensin system combinations given as single pill or identical multipills covering the years 2012 to 2018 were analyzed and followed up to at least 1 year. After 1:1 propensity score matching, persistence to medication, cardiovascular events, and all-cause mortality were compared using non-parametric tests. Results were reported as incidence rate ratios and hazard ratios. Results: After propensity score matching data from 57 998 patients were analyzed: 10 801 patients received valsartan/amlodipine, 1026 candesartan/amlodipine, 15 349 ramipril/amlodipine, and 1823 amlodipine/valsartan/hydrochlorothiazide as single pill or identical multipill. No relevant differences in patient characteristics were observed within the 4 groups. In all groups, a significant lower all-cause mortality, a significant a higher persistence to medication, a significant lower event rate in 15 out of 20 comparisons, and a tendency in the remaining 5 comparisons was observed under single pills compared with multipill combinations. Conclusions: Antihypertensive combination therapy reduces all-cause mortality and cardiovascular when provided as single pill compared to identical drugs as multipills. This strongly supports the European Society of Cardiology/European Society of Hypertension and International Society of Hypertension guidelines recommending the use of a single-pill combination and thus should be more rigorously implemented into daily clinical practice.

Authors with CRIS profile

Roland Schmieder Professur für Innere Medizin (Nephrologie)

Additional Organisation(s)

FAU Profilzentrum Licht.Materie.Quantentechnologien (FAU LMQ)

Involved external institutions

Universität des Saarlandes (UdS) DE Germany (DE) Deutsche Sporthochschule Köln DE Germany (DE) Christian-Albrechts-Universität zu Kiel DE Germany (DE) Herz-Jesu-Krankenhaus Hiltrup DE Germany (DE) APONTIS PHARMA GmbH & Co. KG DE Germany (DE) Institut für Pharmakoökonomie und Arzneimittellogistik e.V. (IPAM) DE Germany (DE) Universitätsklinikum des Saarlandes (UKS) DE Germany (DE)

How to cite

APA:

Schmieder, R., Wassmann, S., Predel, H.G., Weisser, B., Blettenberg, J., Gillessen, A.,... Böhm, M. (2023). Improved Persistence to Medication, Decreased Cardiovascular Events and Reduced All-Cause Mortality in Hypertensive Patients with Use of Single-Pill Combinations: Results from the START-Study. Hypertension, 80(5), 1127-1135. https://dx.doi.org/10.1161/HYPERTENSIONAHA.122.20810

MLA:

Schmieder, Roland, et al. "Improved Persistence to Medication, Decreased Cardiovascular Events and Reduced All-Cause Mortality in Hypertensive Patients with Use of Single-Pill Combinations: Results from the START-Study." Hypertension 80.5 (2023): 1127-1135.

BibTeX: Download