Adherence and health care costs with single-pill fixed-dose combinations in hypertension management.

Abstract

There have been major advances in the understanding of the pathophysiology and treatment of hypertension; however, blood pressure (BP) control in the United States remains suboptimal. Data from the latest National Health and Nutrition Examination Survey (NHANES) indicate that 33% of U.S. adults 20 years of age and older have hypertension. Of these, only 82% are aware that they have hypertension, and only 53% have hypertension adequately controlled. One important consequence of these suboptimal control rates is an increase in cardiovascular morbidity and mortality, which has a substantial impact on both medical resource utilization and overall health care costs. Annual direct medical costs attributable to hypertension are projected to increase from $70 billion to $200 billion (a 186% increase) between 2010 and 2030. Furthermore, if the definition of hypertension-attributable costs is expanded to include the hypertension component of associated cardiovascular disorders, such as heart failure, coronary heart disease, and stroke, the increase in annual spending from 2010 to 2030 is $258 billion, with the overall direct cost rising to $389 billion by 2030. Consequently, cost-effective improvement in the management of hypertension is crucial. Data from large clinical trials demonstrate that it is possible to achieve adequate BP control in patients with hypertension. However, since the pathogenesis of hypertension is typically multifactorial and involves counterregulatory mechanisms, it is frequently difficult to achieve this control using therapy directed at a single factor or mechanism. In most clinical trials, adequate BP control was achieved only when combination therapy involving 2 or more antihypertensive agents was employed. These findings have led the American Society of Hypertension to conclude that at least 75% of patients with hypertension will require 2 or more antihypertensive agents in order to achieve contemporary BP targets. Moreover, it is estimated that at least 25% of patients with hypertension will require 3 or more agents in order to achieve these targets. Single-pill fixed-dose antihypertensive combination therapy simplifies the treatment regimen and may thus provide a convenient treatment option for patients. Such therapy has been shown to be significantly more effective in achieving BP control at 1 year than either free-drug combination therapy (i.e., multiple-pill therapy) or monotherapy. Because some single-pill fixed-dose combination therapies for hypertension are available only as brand-name drugs, drug costs may be COMMENTARY